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The Radial Recurrent Fascial Flap in the Chronic Ulnar Neuropathy at the Elbow
Jean Marc Claise, MD; Jean Paul Haloua;
Clinque de la Chataigneraie, Beaumont, France
Hypothesis: Surgical treatment of ulnar nerve compression sometimes gives incomplete results or recurrences and iterative surgery, with or without transposition, may provide neurological deficit by devascularization and peri-neural fibrosis of the ulnar nerve with neuropathic syndromes very disabling and resistant to medical treatment.
We propose in addition to neurolysis, a wrap of the ulnar nerve and our choice fell on the radial recurrent fascial flap (Radial recurrent artery, first branch of radial artery)
Methods: Our retrospective study of 5 patients, 2 mens (40 and 60) and 3 womens (35, 49 and 53 years) who all had a neurolysis of the ulnar nerve at the elbow to 2 times (3 times) and three times ( 2 times).
They look the same motor and sensory neurological deficit associated with neuropathic pain.
The preoperative electromyography showed signs of denervation without electrical conduction block.
The intervention consisted of a wrap of the ulnar nerve by the radial recurrent fascial flap after neurolysis.
Results: The study involved the analysis of the EVA, neuropathic pain, motor and sensory deficits, the Weber test, the grasp and pinch and motor conduction velocity and sensory.
All patients were reviewed with a decline of 18 months to 4 years.
In all cases, the neurological deficits and decreased neuropathic symptoms decreased or disappeared. All other tests have improved.
Other techniques for wrapping of the ulnar nerve at the elbow (tube or saphenous vein) are discussed.
Summary: The radial recurrent fascial flap seems a promising technique for the recovery of sensory and motor disorders of the ulnar nerve after surgery of the ulnar nerve decompression.
The good results observed in this short series will be confirmed by a study of a larger multicenter series of preference.
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