{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T18:01:58Z","timestamp":1762192918484,"version":"build-2065373602"},"reference-count":54,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T00:00:00Z","timestamp":1761955200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Introduction: Post-traumatic and post-surgical ulnar nerve neuropathies at the elbow and wrist remain challenging conditions often associated with significant sensory and motor impairment. Traditional approaches such as neurolysis alone may be insufficient, especially in complex or recurrent cases. Adipofascial flaps have shown promising outcomes in peripheral nerve surgery. The aim of this study was to evaluate the outcomes of 13 patients with severe ulnar neuropathies who were treated with a size- and shape-personalized adipofascial flap for nerve coverage. Materials and Methods: We retrospectively analyzed 13 patients treated between May 2020 and May 2024 for severe post-traumatic or post-surgical ulnar neuropathies. All underwent surgical decompression, external neurolysis, and adipofascial flap coverage. Pre- and postoperative outcomes were assessed with clinical and neurological evaluations and using the QuickDASH and NRS pain scores. Discussion: All patients showed improvement in pain and sensory-motor function, including those with complications, supporting the role of flap coverage in neuroprotection. This is the first study to describe the use of adipofascial flaps for pseudo-palsy and painful neuroma-in-continuity of the ulnar nerve at the elbow and wrist level. Conclusions: Adipofascial flaps represent a safe, technically feasible, and effective option in complex ulnar nerve injuries, providing both mechanical and biological support. Despite the small cohort, the results suggest strong clinical potential across varied injury patterns.<\/jats:p>","DOI":"10.3390\/jpm15110521","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:32:01Z","timestamp":1762191121000},"page":"521","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Personalized Adipofascial Flap: A Game-Changer for Post-Traumatic Ulnar Nerve Neuropathy at the Wrist and Elbow"],"prefix":"10.3390","volume":"15","author":[{"given":"Alessandro","family":"Greco","sequence":"first","affiliation":[{"name":"Jewish Hospital of Rome, 00148 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Bizzarri","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7144-9655","authenticated-orcid":false,"given":"Lucian Lior","family":"Marcovici","sequence":"additional","affiliation":[{"name":"Jewish Hospital of Rome, 00148 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7095-2010","authenticated-orcid":false,"given":"Alessia","family":"Pagnotta","sequence":"additional","affiliation":[{"name":"Jewish Hospital of Rome, 00148 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/S0363-5023(82)80079-8","article-title":"Anterior submuscular transposition of the ulnar nerves by the Learmonth technique","volume":"7","author":"Leffert","year":"1982","journal-title":"J. Hand Surg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Nyman, E., and Dahlin, L.B. (2024). The Unpredictable ulnar nerve\u2014Ulnar nerve entrapment from anatomical, pathophysiological, and biopsychosocial aspects. Diagnostics, 14.","DOI":"10.3390\/diagnostics14050489"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1142\/S2424835523500480","article-title":"Ulnar-sided upper extremity traumatic wounds: What should we expect to find?","volume":"28","author":"Costa","year":"2023","journal-title":"J. Hand Surg. Asian Pac."},{"key":"ref_4","first-page":"e45477","article-title":"Ulnar Nerve Management in Distal Humerus Fracture Surgery: A Case of Developing Ulnar Neuropathy After Open Reduction and Internal Fixation","volume":"15","author":"Afacan","year":"2023","journal-title":"Cureus"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"993","DOI":"10.3171\/jns.2003.98.5.0993","article-title":"Surgical outcomes of 654 ulnar nerve lesions","volume":"98","author":"Kim","year":"2003","journal-title":"J. Neurosurg."},{"key":"ref_6","first-page":"e51262","article-title":"From conservative measures to surgical interventions, treatment approaches for cubital tunnel syndrome: A comprehensive review","volume":"15","author":"Shelke","year":"2023","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.bja.2023.04.010","article-title":"Postoperative ulnar neuropathy: A systematic review of evidence with narrative synthesis","volume":"131","author":"Hewson","year":"2023","journal-title":"Br. J. Anaesth."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1590\/S0004-282X2011000400021","article-title":"Distal anterior interosseous nerve transfer to the deep ulnar nerve and end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve for treatment of high ulnar nerve injuries: Experience in five cases","volume":"69","author":"Flores","year":"2011","journal-title":"Arq. Neuropsiquiatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1007\/s12178-016-9327-x","article-title":"Ulnar neuropathy: Evaluation and management","volume":"9","author":"Dy","year":"2016","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S45","DOI":"10.1097\/SAP.0000000000001727","article-title":"Prognosis of traumatic ulnar nerve injuries: A systematic review","volume":"82","author":"Lan","year":"2019","journal-title":"Ann. Plast. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1227\/00006123-198704000-00015","article-title":"Neurolysis combined with the application of a silastic envelope for ulnar nerve entrapment at the elbow","volume":"20","author":"Benoit","year":"1987","journal-title":"Neurosurgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00701-013-1962-z","article-title":"Comparative outcomes of ulnar nerve transposition versus neurolysis in patients with entrapment neuropathy at the cubital tunnel: A 20-year analysis","volume":"156","author":"Kamat","year":"2014","journal-title":"Acta Neurochir."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103062","DOI":"10.1016\/j.eats.2024.103062","article-title":"Arthroscopic extra-articular ulnar nerve release in the setting of stiff elbow","volume":"13","author":"Zhang","year":"2024","journal-title":"Arthrosc. Tech."},{"key":"ref_14","first-page":"e23.00108","article-title":"Ulnar nerve compression at the elbow secondary to intramuscular lipoma of the flexor carpi ulnaris: A case report","volume":"13","author":"Fisher","year":"2023","journal-title":"JBJS Case Connect."},{"key":"ref_15","first-page":"00115","article-title":"Surgical outcome of ulnar nerve lesions: Not always disappointing","volume":"3","author":"Emamhadi","year":"2015","journal-title":"J. Neurol. Stroke"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Podsednik, A., Cabrejo, R., and Rosen, J. (2022). Adipose tissue uses in peripheral nerve surgery. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23020644"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Greco, A., Marcovici, L.L., Molayem, I., Amendola, C., and Pagnotta, A. (2025). Management of the ulnar nerve using an adipofascial flap in elbow surgery. Musculoskelet. Surg.","DOI":"10.1007\/s12306-025-00916-7"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.hansur.2021.03.010","article-title":"A novel local adipofascial flap for the management of recalcitrant ulnar tunnel syndrome","volume":"40","author":"Pagnotta","year":"2021","journal-title":"Hand Surg. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1142\/S2424835524500127","article-title":"Adipofascial Perforator Flaps for Peripheral Nerve Resurfacing after External Neurolysis","volume":"29","author":"Calotta","year":"2024","journal-title":"J. Hand Surg. Asian Pac."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.jhsa.2013.12.005","article-title":"Use of a pedicled adipose flap as a sling for anterior subcutaneous transposition of the ulnar nerve","volume":"39","author":"Danoff","year":"2014","journal-title":"J. Hand Surg."},{"key":"ref_21","first-page":"89","article-title":"Adipose flap versus fascial sling for anterior subcutaneous transposition of the ulnar nerve","volume":"45","author":"Verveld","year":"2016","journal-title":"Am. J. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lo Torto, F., Patan\u00e8, L., Abbaticchio, D., Pagnotta, A., and Ribuffo, D. (2024). Autologous Fat Grafting (AFG): A systematic review to evaluate oncological safety in breast cancer patients. J. Clin. Med., 13.","DOI":"10.3390\/jcm13154369"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Lo Torto, F., Turriziani, G., Carella, S., Pagnotta, A., and Ribuffo, D. (2024). Impact of the prepectoral breast reconstruction assessment score on expander-based reconstruction success. J. Clin. Med., 13.","DOI":"10.3390\/jcm13216466"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1007\/s00266-018-1120-3","article-title":"From the \u201cFat Capsule\u201d to the \u201cFat Belt\u201d: Limiting protective lipofilling on irradiated expanders for breast reconstruction to selective key areas","volume":"42","author":"Vaia","year":"2018","journal-title":"Aesthet. Plast. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/j.jhsa.2014.01.007","article-title":"Treatment of painful median nerve neuromas with radial and ulnar artery perforator adipofascial flaps","volume":"39","author":"Adani","year":"2014","journal-title":"J. Hand Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/S0363-5023(96)80201-2","article-title":"The hypothenar fat pad flap for management of recalcitrant carpal tunnel syndrome","volume":"21","author":"Strickland","year":"1996","journal-title":"J. Hand Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1002\/jnr.23284","article-title":"Neuromodulatory nerve regeneration: Adipose tissue-derived stem cells and neurotrophic mediation in peripheral nerve regeneration","volume":"91","author":"Widgerow","year":"2013","journal-title":"J. Neurosci. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1159\/000369336","article-title":"Adipose-derived stem cells for nerve repair: Hype or reality?","volume":"200","author":"Kingham","year":"2014","journal-title":"Cells Tissues Organs"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.bjps.2004.06.020","article-title":"Ulnar recurrent adipofascial flap for reconstruction of massive defects around the elbow and forearm","volume":"57","author":"Hayashi","year":"2004","journal-title":"Br. J. Plast. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"100320","DOI":"10.1016\/j.jham.2025.100320","article-title":"Pedicled adipofascial flaps for treatment and prophylaxis of neurodesis and neuromas in continuity of the upper extremity: A case series of 22 patients","volume":"17","year":"2025","journal-title":"J. Hand Microsurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1097\/SAP.0000000000002083","article-title":"The epidemiology of upper extremity nerve injuries and associated cost in the US Emergency Departments","volume":"83","author":"Tapp","year":"2019","journal-title":"Ann. Plast. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"539","DOI":"10.5505\/tjtes.2011.75735","article-title":"The incidence of peripheral nerve injury in trauma patients in Iran","volume":"17","author":"Saadat","year":"2011","journal-title":"Ulus. Travma Ve Acil Cerrahi Derg."},{"key":"ref_33","first-page":"191","article-title":"Electrodiagnostic findings in 441 patients with ulnar neuropathy\u2014A retrospective study","volume":"11","author":"Raeissadat","year":"2019","journal-title":"Orthop. Res. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S25","DOI":"10.1007\/s12306-010-0065-8","article-title":"Management of complex elbow instability","volume":"94","author":"Giannicola","year":"2010","journal-title":"Musculoskelet. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1302\/0301-620X.100B5.BJJ-2017-1057.R2","article-title":"Results of primary repair of distal triceps tendon ruptures in a general population: A multicentre study","volume":"100-B","author":"Giannicola","year":"2018","journal-title":"Bone Jt. J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.jns.2005.02.010","article-title":"Incidence of ulnar neuropathy at the elbow in the province of Siena (Italy)","volume":"234","author":"Mondelli","year":"2005","journal-title":"J. Neurol. Sci."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Cepeda, I., Sanz-Pe\u00f1as, A.-E., de Blas-Sanz, I., Sim\u00f3n-P\u00e9rez, C., Frutos-Reoyo, E.-J., and Aguado-Maestro, I. (2025). Post-Surgical ulnar nerve neuropathy in distal humerus fractures: Comparison between in situ decompression and anterior subcutaneous transposition. J. Clin. Med., 14.","DOI":"10.3390\/jcm14072490"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.2106\/JBJS.F.00594","article-title":"The ulnar nerve in elbow trauma","volume":"89","author":"Shin","year":"2007","journal-title":"J. Bone Jt. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1016\/j.clinph.2018.02.089","article-title":"O-3-14. Treatment of ulnar neuropathy after total elbow arthroplasty (TEA) and nerve conduction test","volume":"129","author":"Katayama","year":"2018","journal-title":"Clin. Neurophysiol."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Faccenda, C., Dutto, E., Bosco, F., Lavia, A.D., and Battiston, B. (2024). Ulnar nerve management in complex elbow dislocations: A retrospective monocentric study. J. Pers. Med., 14.","DOI":"10.3390\/jpm14111076"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Jewett, C., and Desai, M. (2022). Median and ulnar nerve injury at the elbow and wrist. Peripheral Nerve Issues After Orthopedic Surgery, Springer International Publishing.","DOI":"10.1007\/978-3-030-84428-8_8"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"103436","DOI":"10.1016\/j.eats.2025.103436","article-title":"Dry elbow arthroscopy: Positive pressure to improve tissue distension","volume":"14","author":"Greco","year":"2025","journal-title":"Arthrosc. Tech."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Tr\u0119bacz, P., Frymus, J., Pawlik, M., Barteczko, A., Kurkowska, A., Berczy\u0144ska, J., and Czopowicz, M. (2025). Risk of Ulnar Nerve Injury Following Caudo-Medial Arthroscopic Portal Creation in the Canine Elbow\u2014A Cadaveric Study. Animals, 15.","DOI":"10.3390\/ani15040543"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1177\/0363546518765139","article-title":"Ulnar Nerve complications after ulnar collateral ligament reconstruction of the elbow: A systematic review","volume":"47","author":"Clain","year":"2019","journal-title":"Am. J. Sports Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1302\/0301-620X.87B4.15692","article-title":"Total elbow arthroplasty: A systematic review of the literature in the English language until the end of 2003","volume":"87","author":"Little","year":"2005","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13643-020-01388-5","article-title":"Efficacy of tubing technique with biomaterials compared to direct coaptation technique after peripheral neurotmesis in nerve healing and return to functionality in young adult rats: A systematic review protocol","volume":"9","author":"Brito","year":"2020","journal-title":"Syst. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Podnar, S. (2023). No major nerve regeneration seems to occur during recovery of ulnar neuropathy at the elbow. J. Clin. Med., 12.","DOI":"10.3390\/jcm12123906"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1097\/00003086-198203000-00007","article-title":"Timing for exploration of nerve lesions and evaluation of the neuroma-in-continuity","volume":"163","author":"Kline","year":"1982","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1016\/j.bjps.2020.10.085","article-title":"Nerve wrapping for recurrent compression neuropathy: A systematic review","volume":"74","author":"Thakker","year":"2021","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.58616\/001c.90454","article-title":"Use of Nerve Wraps in the Upper Extremity","volume":"2","author":"Fones","year":"2024","journal-title":"SurgiColl"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jassh.2004.06.009","article-title":"Vein wrapping for recurrent median nerve compression","volume":"4","author":"Sarris","year":"2004","journal-title":"J. Hand Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.jhsa.2020.07.016","article-title":"A Multicenter Matched Cohort Study of Processed Nerve Allograft and Conduit in Digital Nerve Reconstruction","volume":"45","author":"Leversedge","year":"2020","journal-title":"J. Hand Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1016\/j.jhsa.2012.08.028","article-title":"Functional Outcome Following Nerve Repair in the Upper Extremity Using Processed Nerve Allograft","volume":"37","author":"Cho","year":"2012","journal-title":"J. Hand Surg."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"DeVitis, R., D\u2019Orio, M., Cannella, A., Michel Gabriel, E., Taccardo, G., Marzella, L., Cilli, V., Sassara, G.M., and Passiatore, M. (2025). Short-Term outcomes of a novel fascio-aponeurotic flap technique for ulnar nerve instability at the elbow. 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