Surgical management of peripheral nerve disorders aims to prevent recurrent compression caused by adhesion and scarring following neurolysis or nerve repair. Conventional approaches include neurolysis, removal of scar tissue, and prevention of perineural adhesion. Coverage of the nerve with well-vascularized tissue has been considered essential to minimize re-adhesion, and various wrapping techniques using muscle flaps, skin flaps, and adipofascial flaps have been developed.
Numerous procedures have been reported for recurrent cases after carpal tunnel release, for which neurolysis of the median nerve is required. Historically, nerve wrapping using muscle flaps began in the 1980s with the pronator quadratus muscle flap, followed by the palmaris brevis flap in the 1990s. Subsequently, radial artery–based fascial flaps, vein wrapping, and hypothenar fat pad flaps were introduced.
More recently, perforator-based adipofascial and adipose flaps that preserve the major artery have gained attention. This article reviews the evolution of these techniques and highlights the clinical utility of pedicled perforator adipose flaps for nerve wrapping.
