Published online Nov 18, 2017. doi: 10.5312/wjo.v8.i11.846
Peer-review started: February 2, 2017
First decision: June 26, 2017
Revised: July 10, 2017
Accepted: September 3, 2017
Article in press: September 4, 2017
Published online: November 18, 2017
To compared outcomes between the hypothenar fat pad flap (HTFPF) and conventional open carpal tunnel release (COR) in primary carpal tunnel syndrome (CTS).
Forty-five patients (49 hands) were enrolled into the study from January 2014 to March 2016, 8 patients were excluded. Randomization was conducted in 37 patients (41 hands) by computer generated (Block of four randomization) into COR and HTFPF group. Nerve conduction study (NCS) included distal sensory latency (DSL), distal motor latency (DML), sensory amplitude (S-amp), motor amplitude (M-amp) and sensory nerve conduction velocity (SCV) were examined at 6 and 12 wk after CTR. Levine score, grip and pinch strength, pain [visual analog scale (VAS)], 2-point discrimination (2-PD), Semmes-Weinstein monofilament test (SWM), Phalen test and Tinel’s sign were evaluated in order to compare treatment outcomes.
The COR group, 19 patients (20 hands) mean age 50.4 years. The HTFPF group, 20 patients (21 hands) mean age 53.3 years. Finally 33 patients (36 hands) were analysed, 5 patients were loss follow-up, 17 hands in COR and 19 hands in HTFPF group. NCS revealed significant difference of DSL in HTFPF group at 6 wk (P < 0.05) compared with the COR group. S-amp was significant improved postoperatively in both groups (P < 0.05) but not significant difference between two groups. No significant difference of DML, M-amp and SCV postoperatively in both groups and between two groups. Levine score, pain (VAS), grip and pinch strength, 2-PD, SWM, Phalen test and Tinel’s sign were improved postoperatively in both groups, but there was no significant difference between two groups.
There is no advantage outcome in primary CTS for having additional HTFPF procedure in CTR. COR is still the standard treatment. Nevertheless, improvement of DSL and S-amp could be observed at 6 wk postoperatively.
Core tip: The study conducted a randomized controlled trial to compare between the hypothenar fat pad flap additional and conventional open carpal tunnel release in primary carpal tunnel syndrome. The study showed no advantage, however improvement of nerve conduction study was observed in the early postoperatively.