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Retrospective Review: Revision Carpal Tunnel Release at a Single Institution
Tantien Nguyen, BS
1, Victor T. Hung, M.D.
2, Humberto Cardona, MS
1, Joshua U Hancock, BS
1, Daniel Bailey, M.D.
3, Monic Amin, MD
4; Michael C Doarn, MD
5(1)Foundation For Orthopaedic Research and Education, Tampa, FL, (2)Foundation for Orthopaedic Research and Education, Tampa, FL, (3)University of South Florida Health Morsani College of Medicine, Tampa, FL, (4)Morsani College of Medicine, University of South Florida, Tampa, FL, (5)Hand and Upper Extremity Surgery, Florida Orthopaedic Insititue, Tampa, FL
Introduction
Carpal tunnel release (CTR), whether performed via endoscopic or open approach, is generally effective in resolving paresthesia. However, some patients continue to experience symptoms following initial surgery and may require revision procedures. This study aims to evaluate patient outcomes after revision CTR, specifically comparing different revision techniques-including HA+ nerve wrap, hypothenar fat flap (HTFF), and other nerve wraps-to determine which method offers the most favorable results.
Materials and Methods
Institutional review board approval was obtained for this retrospective study of patients who underwent revision CTR at a single tertiary center from January 2010 to January 2025. Patients were identified via surgical billing records using CPT code 64721, with inclusion limited to revision CTR cases. Exclusion criteria were primary open CTR only, age over 89, and inadequate follow-up. Patients were grouped into HTFF, HA+, and other techniques. A total of 55 patients met criteria: 16 in the HA+ group, 29 in the HTFF group, and 10 in the other group. The primary outcome was postoperative complication incidence; secondary outcomes included QuickDASH scores at baseline, final follow-up, and overall change.
Results
The three groups were similar demographically. The HA+ group showed a trend toward a higher overall complication rate and had a significantly higher complication rate compared to the HTFF group (p = 0.05). QuickDASH scores at baseline, final follow-up, and overall change were comparable across all groups at each time point. Notably, the HA+ and other groups started with higher baseline QuickDASH scores than the HTFF group, which may have contributed to greater potential for improvement. The need for additional procedures was similar among groups, though 13% of the HA+ group required further surgery compared to 4% in the HTFF group (p=0.285).
Conclusion
In conclusion, the study is underpowered but overall allows for insight on the trends for each technique in revision CTR. The standard revision CTR technique is HTFF for its reliability and low complication rate which is shown in this study. HA+ nerve wraps show promising improvements in outcomes; however, they present specific challenges that need to be addressed to establish them as a superior alternative for CTR without increasing complication rates.
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