1. PEDICLED ADIPOFASCIAL FLAP FOR ULNAR NERVE ANTERIOR TRANSPOSITION: A Single Institution Retrospective Outcomes Report
Leversedge FJ, Shammas RL, Koehler SM. Dept. of Orthopaedic Surgery - Duke University; Durham, NC USA
PURPOSE: To assess outcomes of ulnar nerve decompression and anterior transposition at the elbow using a pedicled adipofasical flap.
METHODS: A retrospective cohort of patients who underwent primary or revision ulnar neuroplasty and anterior transposition using an adipofascial flap for a preoperative diagnosis of ulnar neuropathy at the elbow at a single center between was examined. Pre-and post-operative visual analogue scale scores, modified McGowan classifications, complications, and physical exam findings were used to assess patient outcomes.
RESULTS: 22 patients underwent ulnar nerve decompression with anterior transposition using an adipofascial flap, and 16 patients were eligible for inclusion in the study. 11 cases were primary nerve procedures and 5 patients were revision ulnar nerve surgery with a mean postoperative follow-up time of 352 days (range: ). There was a significant mean improvement in global intrinsic strength when comparing pre- and post-operative measures (3.7/5 v. 4.6/5, p<0.05 ). 50% of patients had improvement in their two-point discrimination postoperatively. Following the operation, all patients experienced a significant reduction in their VAS pain scores (4/10 v. 0.6/10, p<0.05). 12 of 16 of patients were classified as demonstrating an improvement in their modified McGowan classification score, while 4 out of 16 were classified as having no change. No patient had a worse post-operative score. All patients maintained preoperative elbow range of motion. There were no perioperative complications.
CONCLUSIONS: Use of the adipofascial flap for anterior transposition of the ulnar nerve at the elbow generally provided patients with significant improvement in measured clinical outcomes, even in the revision setting. Ulnar nerve sensation and global intrinsic strength improved postoperatively, corroborating the initial published report that analyzed this technique. In patients for whom ulnar nerve decompression with or without anterior transposition is indicated, anterior transposition using an adipofascial flap may be a valuable technique for improving nerve function and for improving overall patient outcomes. 1A 1B
1A and 1B. Intraoperative example of failed ulnar nerve
anterior transposition 2B
2. Development of superficial and deep subcutaneous
layers, defined by membranous tissue plane 3
3. Ulnar nerve positioning between the
subcutaneous layers prior to flap stabilization