Autologous nerve coverage in revision surgery for recurrent or persistent carpal tunnel syndrome: A systematic review and meta-analysis.

Abstract

Initial carpal tunnel surgery fails in about 5% to 10% of cases, with revision rates from 0.3% to 7%. When repeated release is not feasible, autologous nerve coverage may be beneficial, although the optimal technique remains uncertain. The aim of this review was to systematically analyze postoperative outcomes of the different types of autologous nerve coverage techniques for recurrent or persistent carpal tunnel syndrome. A systematic review and meta-analysis of studies was performed in accordance with the PRISMA guidelines. Literature was searched in PubMed, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). Among the 26 included studies, 8 different nerve coverage techniques were identified, but only 2 could be compared. Based on a random-effects model, meta-analysis showed that the hypothenar fat pad and the synovial flap both seem to be effective procedures, with more patients achieving complete relief of symptoms, satisfaction, and pain improvement in the hypothenar fat pad group.