Treatment of Failed Carpal Tunnel Syndrome by Dorsal Ulnar Artery Perforator Adipofascial Flap

"Treatment of failed carpal tunnel syndrome by dorsal ulnar artery perforator adipofascial flap The previous incision is reopened and extended, Neurolysis begins proximally preserving the palmar cutaneous branch. The subcutaneous tissue is exposed, leaving part of the superficial venous plexus with the adipofascial flap. Flap elevation is begun by incising the subcutaneous tissue through the deep fascia along the radial border of FCU and ECU .~When the flap reaches a suitable length (10-12 cm from the wrist), it is cut proximally and along the ulnar side. The flap is dissected proximally to distally in continuity with the underlying fascia . When the dissected flap is (2-5) cm proximal to the wrist. Ulnar retraction of the flexor carpi ulnaris permits identification of the perforator. the pivot point of the flap is localized (2-5) cm proximal to the pisiform.~The adipofascial flap is turned 180 degrees and anchored with a few absorbable stitches around the median nerve."