Circumferential wrapping of a flap around a scarred peripheral nerve for salvage of end-stage traction neuritis

Abstract

Nine patients with chronic severe pain due to end-stage traction neuritis of an intact peripheral nerve underwent external neurolysis and epineurectomy or epineurectomy and internal neurolysis followed by circumferential wrapping of the involved segment of nerve with a pedicle flap or free flap consisting of either subcutaneous fat tissue, fascia, or muscle. Seven patients (77%) followed for between 1 and 5 years had substantial relief of pain. Two patients (22%) had no decrease in their pain at all. Circumferential wrapping may cushion the nerve from external pressure on the overlying skin, may isolate the nerve from the traction forces of adjacent moving tendons to allow improved gliding of the nerve, and may promote revascularization of a scarred nerve. This surgery may be indicated for patients with persistent pain following multiple carpal tunnel or cubital tunnel surgeries.