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Recurrent and persistent carpal tunnel syndrome: "Triple-therapy approach".
Spielman, Amanda F; Sankaranarayanan, Sriram; Skowronski, Piotr; Lessard, Anne-Sophie; Panthaki, Zubin.
Afiliação
  • Spielman AF; University of Miami, Miller School of Medicine, Miami, FL, USA.
  • Sankaranarayanan S; Department of Orthopedic Surgery, NYU Langone Health, New York City, NY, USA.
  • Skowronski P; Burn and Reconstructive Centers of America, Doctors Hospital, Augusta, GA, USA.
  • Lessard AS; Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Department of Surgery, Miami, FL, USA.
  • Panthaki Z; Division of Plastic and Reconstructive Surgery, DeWitt Daughtry Department of Surgery, Miami, FL, USA.
J Orthop ; 22: 431-435, 2020.
Article em En | MEDLINE | ID: mdl-33041567
ABSTRACT

BACKGROUND:

Various procedures have been described for patients undergoing a revision carpal tunnel release. These can include repeat open decompression with external or internal neurolysis, tenosynovectomy, endoscopic release, various flap techniques, saphenous vein wrapping and use of prosthetic implants. This study reports a case series of 30 consecutive patients who underwent revision carpal tunnel release at single institution from 2012 to 2018. Our surgical plan in all the patients involved a combination of these three techniques (triple therapy approach) neurolysis (external or internal) and tenosynovectomy, collagen matrix conduit wrap (NeuraWrap; Integra LifeSciences or Axoguard Nerve Protector, AxoGen Inc), and hypothenar fat flap. MATERIALS AND

METHODS:

A total of 30 patient records were identified. The index surgery was performed by a variety of surgeons at varied private institutions as well as the VA hospital. However, all of the revision interventions in this series were performed by the senior author (Z.J.P.). Demographic data (age, sex, hand dominance, comorbidities, alcohol, and smoking history) were collected. Preoperative and postoperative symptoms were recorded for all patients, including subjective outcomes, need for additional surgery and complications. Mean VAS preoperatively and postoperatively were compared using a paired t-test. All statistical analyses were performed with SPSS 20 (IBM, Chicago, IL).

RESULTS:

Patient reported measures of resolution of symptoms and VAS scores documented at 3 months. Of the 30 patients who underwent surgery for persistent or recurrent carpal tunnel syndrome, symptoms resolved completely in 25 patients. 2 patients were lost to follow up. 3 patients showed no improvement. The mean preoperative VAS score was 4.37 and declined to 1.23 after surgery (P < .0001).

CONCLUSION:

Our study demonstrates that a combination of neurolysis and tenosynovectomy along with a nerve wrap and hypothenar fat flap should be considered in patients presenting with recurrent or persistent carpal tunnel syndrome.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Revista: J Orthop Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies Idioma: En Revista: J Orthop Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Estados Unidos