Abstract
Adhesion neuropathy of the median nerve with persistent wrist pain can be challenging. In the present study, we introduced a novel method using a radial artery perforator (RAP) adipose flap for coverage of the neurolysed median nerve to minimize reformation of scar adhesion. Seven patients who had previously undergone median nerve surgeries, repair of a median nerve laceration or primary open carpal tunnel release were included. As all patients had substantial median nerve hypersensitivity, secondary neurolysis and coverage with the RAP adipose flap were performed. The average follow-up was 15 months (range 6-28 months). The RAP adipose flap size ranged from 750 to 1,800 mm² (average 1,093 mm²), and was sufficient to cover the exposed median nerve. After surgery, the positive Tinel sign at the wrist disappeared in all patients and the mean visual analogue pain scale score decreased. Furthermore, the average scores for the Quick DASH and Hand 20 improved postoperatively. The results of interposing the RAP adipose flap between dysesthetic volar wrist skin and the neurolysed median nerve were positive in terms of both pain relief and restoration of hand function.
