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Theme: Inclusion and Collaboration Theme: Inclusion and Collaboration

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Outcomes of Ulnar Nerve Anterior Transposition Using a Pedicled Adipofascial Flap
Fraser J. Leversedge, MD; Department of Orthopaedic Surgery, DUKE UNIVERSITY, Durham, NC; Steven M. Koehler, MD; Orthopaedic Surgery, Duke University, Durham, NC

Introduction: We hypothesize that the use of a pedicled adipofasical flap for ulnar nerve anterior transposition results in adequate ulnar nerve decompression and, by serving as a scar tissue barrier and an optimal milieu for vascular regeneration, improves objective findings associated with ulnar neuropathy.

Methods: Patients who underwent an ulnar nerve anterior transposition with an adipofascial flap for a preoperative diagnosis of cubital tunnel syndrome at a single center between 2006-2016 were reviewed. Inclusion criteria included idiopathic cubital tunnel syndrome with a minimum of two postoperative visits.  Exclusion criteria included concomitant carpal tunnel release, elbow contracture release, elbow trauma, and skeletally immature patients.  Pre-and post-operative visual analogue scale scores, modified McGowan classifications, complications, and physical exam findings were used to assess patient outcomes.   

Results: 22 patients underwent ulnar nerve anterior transposition with an adipofascial flap, and 16 patients were eligible for inclusion in the study.  The mean age and BMI are shown in Table 1. Patients experienced symptoms of ulnar neuropathy for an average 15.6 months prior to operative intervention. 6 patients (38%) underwent adipofascial flap transposition as revision ulnar nerve surgery. The mean post-operative follow-up time was 198.7 days (range, 23-535). There was a significant mean improvement in global intrinsic strength when comparing pre- and post-operative measures (Table 2). Following the operation, all patients experienced a significant reduction in their VAS pain scores (Table 2). 8 of 16 of patients were classified as demonstrating an improvement in their modified McGowan classification score, while 7 out of 16 were classified as having no change, and 1 out of 16 was classified as having a worse post-operative score (Table 2). One patient experienced an infection requiring oral antibiotics. No other complications were noted.  All patients maintained full preoperative elbow range of motion.

Conclusion:  Decompression of the ulnar nerve with a pedicled adipofasical flap provides a successful alternative to subcutaneous, subfascial or submuscular transposition. The technique results in significant improvement in pain and global intrinsic strength post-operatively. The technique is simple and safe and is well suited to revision nerve surgery.

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