Back to 2026 Abstracts
Optimizing autologous nerve coverage techniques for recurrent carpal tunnel syndrome: a meta-analysis and predictive modeling framework.
Bayan Ghalimah, MBBS, FRCSC
1, Yazan Alalwani, Medical Student
2, Nihal Alqahtani, Medical Student
3, Imtinan AlJabbar, Medical Student
4, Roaa Alghamdi, Medical Student
1, Mujtaba Alobbaid, Medical Student
5, Rahaf Alruwili, Medical Student
6, Raghad Sonbul, Medical Student
7, Osama Alharbi, Medical Student
3, Rana Arab, Medical Student
8, Tala Alkhunani, Medical Student
3, Ahmed Azzam, Medical Student
2; Amre Hamdi, MBBS, FRCSC
1(1)King Abdulaziz University, Jeddah, SA, Saudi Arabia, (2)Imam Abdulrahman Bin Faisal University, Dammam, SA, Saudi Arabia, (3)King Saud University, Jeddah, SA, Saudi Arabia, (4)King Khalid University, Jeddah, SA, Saudi Arabia, (5)Shaqra University, Jeddah, SA, Saudi Arabia, (6)Aljouf University, Jeddah, SA, Saudi Arabia, (7)Imam Abdulrahman Bin Faisal University, Jeddah, SA, Saudi Arabia, (8)Al-Laith General Hospital, Jeddah, SA, Saudi Arabia
Background
Recurrent or persistent carpal tunnel syndrome presents a significant therapeutic challenge, with around 5% to 10% of patients experiencing failure after initial surgical management. When a simple re-release is not feasible due to extensive scarring or multiple previous surgeries, autologous nerve coverage techniques offer an alternative approach. However, the optimal coverage technique remains uncertain. We conducted a systematic review and meta-analysis to compare outcomes across different autologous nerve coverage techniques and identify factors influencing success.
Methods
Following PRISMA 2020 guidelines, we searched multiple databases without date or language restrictions. Studies including at least ten patients undergoing autologous nerve coverage for recurrent/persistent carpal tunnel syndrome were included. Primary outcomes included overall improvement, complete symptom relief, patient satisfaction, and pain improvement. Random-effects meta-analysis was performed, and correlations between biological properties and outcomes were analyzed.
Results
Twenty-six studies with total of 585 patients and 607 hands, evaluating eight different techniques were included. The hypothenar fat pad flap demonstrated superior complete symptom resolution (69.7%, 95%CI:61.1-78.4%) compared to the synovial flap (26.3%, 95%CI:17.6-34.9%). Longer intervals between surgeries (OR:2.36,
P-value=0.001), fewer prior procedures (OR:3.57,
P-value <0.001), and absence of diabetes (OR:0.47,
P-value = 0.002) or rheumatoid arthritis (OR:0.35,
P-value = 0.003) strongly predicted favorable outcomes. Regenerative potential (
r=0.53,
P-value=0.015), vascularization(
r=0.48,
P-value=0.037), and tissue thickness (
r=0.41,
P-value=0.044) significantly correlated with success.
Conclusions
The hypothenar fat pad flap achieves the best outcomes for most revision scenarios due to its balanced biological properties. When feasible, revision surgery should be delayed beyond 12-months from first procedure. Patient-specific factors significantly impact outcomes and should guide technique selection. Future studies should focus on prospective comparative studies with standardized outcome measures and validated risk stratification models to refine patient-specific treatment algorithms.
Back to 2026 Abstracts
