Adipofascial Flap for Revision Cubital Tunnel Surgery: Indications and Outcomes
Hannah C Langdell, MD1, William M. Tian, BS2, Steven L Zeng, BA2, Amanda R Sergesketter, MD1, Jeremy E Raducha, MD2 and Suhail K. Mithani, MD3, (1)Duke University Medical Center, Durham, NC, (2)Duke University, Durham, NC, (3)Plastics and Reconstructive Surgery, Duke University Medical Center, Durham, NC
Introduction: A pedicled adipofascial flap can be utilized during revision cubital tunnel surgery to surround the nerve in vascularized tissue and potentially prevent perineural scarring. This study aims to determine the outcomes for patients undergoing an adipofascial flap for revision surgery after failed in situ decompression and compare the outcomes to other techniques employed in revision cubital tunnel surgery.
Materials and Methods: A single institution, retrospective review was performed for all patients who underwent revision surgery for non-traumatic cubital tunnel syndrome from 2017-2023. Patient demographics, visual analog pain scores, presence of numbness, weakness, subluxation, atrophy, patient-reported outcome measurement information system (PROMIS) scores, nerve conduction results, and complications were collected. Patients were included in this study that failed a primary in situ decompression and subsequently had a revision procedure.
Results: Thirty-four patients underwent revision with an adipofascial flap, and 16 patients had revision surgery without an adipofascial flap (Figure 1). Pain scores, numbness, and weakness significantly improved in both groups after revision surgery (p<0.01). The adipofascial group trended towards being younger (p=0.10) and had significantly fewer patients reporting post-operative weakness (p=0.043). Nerve wraps were more commonly used in patients without an adipofascial flap (75%) compared to the cohort of patients who received an adipofascial flap (8.82%) (p<0.01). There was a significantly shorter time interval between the primary and revision surgeries for patients who received an adipofascial flap (p=0.004) (Table 1). There were no significant differences in complication profiles between the groups.
Conclusions: In the largest cohort of adipofascial flaps to date, this study demonstrates that adipofascial flaps are an efficacious option for revision cubital tunnel surgery that result in less post-operative weakness compared to transposition with or without a nerve wrap. However, patients should be advised that persistent numbness and weakness were still present in 46% and 16% of revision patients, respectively. An adipofascial flap is a cost-effective alternative to a nerve wrap that may be more advantageous in younger patients with a shorter time interval from primary release to revision due to less global scarring, which may preclude elevation of a robust flap.
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