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Hypothesis: In patients with cubital tunnel syndrome, we hypothesize that a pedicled adipofascial flap is a safe and effective procedure to secure the ulnar nerve during anterior subcutaneous transposition. The purpose of this study is to report follow-up results in patients undergoing this novel procedure over the course of 9 years.

Methods: Between April 2001 and May 2010, the senior author performed 22 anterior transposition procedures with a pedicled adipofascial flap for primary cubital tunnel syndrome. In this novel procedure, a vascularized adipofascial flap is elevated and wrapped around the transposed ulnar nerve. It will cushion and shield the nerve from surrounding tissue adherence, while performing sling function preventing nerve subluxation.  Furthermore, it may assist in normal nerve gliding as it mimics the normal perineural fat.  The vascularity and the potential fat cells may also enhance nerve recovery. Patients were evaluated utilizing the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, visual analogue scale (VAS), physical examination, and a questionnaire of patient function.

Results: Thirteen patients were available for questionnaires and examination and 3 patients completed the questionnaires only.  The mean patient age at surgery was 55.2 years (range 28-81 years) and mean follow-up was 3.6 years (range 7 months-10 years).  The mean DASH score was 19.0 (SD 14.6, range 0.8-54.2) and the mean VAS score for pain was 1.7 (SD 2.4). The mean VAS score for numbness and paresthesias was 3.3 (SD 3.2) and 3.3 (SD 2.9) respectively.  Elbow mobility was preserved when compared to the contralateral extremity (93% for flexion-extension arc, and intrinsic strength was 96% for key pinch). Patients reported a mean 94% satisfaction with the outcome. There were no post-operative complications and no recurrences of cubital tunnel syndrome requiring revision surgery.

Conclusion: The use of a pedicled adipofascial flap as a sling during anterior subcutaneous transposition of the ulnar nerve is a safe and effective procedure for the treatment of cubital tunnel syndrome. The majority of patients obtained satisfactory results with resolution of motor and sensory symptoms. This novel technique may have advantages as a pliable, vascular fat envelope, which mimics the natural fatty environment of peripheral nerves.