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A Systematic Review of the Literature on the Outcomes of Treatment for Recurrent and Persistent Carpal Tunnel Syndrome

Soltani, Ali M. M.D.; Allan, Bassan J. M.D.; Best, Matthew J. B.S.; Mir, Haaris S. M.D.; Panthaki, Zubin J. M.D., C.M.

Plastic & Reconstructive Surgery: July 2013 - Volume 132 - Issue 1 - p 114–121
doi: 10.1097/PRS.0b013e318290faba
Hand/Peripheral Nerve: Outcomes Article
Video Discussion
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Background: Recurrent and persistent carpal tunnel syndrome is an uncommon but potentially difficult surgical dilemma. Many surgical treatment options have been described in the literature without comparative data on outcome.

Methods: A systematic review on recurrent carpal tunnel syndrome was performed for all articles from 1946 to 2012 in MEDLINE, EMBASE, CENTRAL, and hand-searched reference lists from all identified articles. Twenty-three articles were screened and identified from the time period 1972 to 2012, representing two general treatment groups: decompression with flap interposition and repeated open decompression. A meta-analysis was then performed, generating forest and funnel plots of the data.

Results: In total, 294 patients from 14 studies in the flap arm of the meta-analysis had a weighted success rate of 86 percent (95 percent CI, 0.75 to 0.96), and 364 patients from nine studies in the nonflap arm had a weighted 75 percent success rate (95 percent CI, 0.66 to 0.84). Heterogeneity was statistically analyzed and revealed low heterogeneity with the I2 statistic. Forest plots were created and analyzed between subgroups, and chi-square analysis revealed a highly statistically significant difference (p = 0.001). The odds ratio of success in the nonflap group was 0.50 (95 percent CI, 0.33 to 0.75).

Conclusions: Decompression with the use of vascularized flap coverage appears to have a higher success rate over simple repeated decompression. The relevance of these data is pertinent to all hand surgeons, as they could have an impact on treatment guidelines for this relatively uncommon but problematic condition, but further prospective study is needed.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Miami, Fla.

From the Department of Surgery, Division of Plastic, Aesthetic, and Reconstructive Surgery, University of Miami, Miller School of Medicine.

Received for publication December 2, 2012; accepted January 30, 2013.

Abstract presented at the Plastic Surgery Research Council meeting, in Santa Monica, California, May 4, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

A Video Discussion by Jonathan Cheng, M.D., accompanies this article. Go to PRSJournal.com and click on “Video Discussions” in the “Videos” tab to watch.

Ali Soltani, M.D., 1120 NW 14th Street, CRB Suite 402, Miami, Fla. 33136, asoltani@med.miami.edu

©2013American Society of Plastic Surgeons