Comfortable, Permanent, and Safe Relocation of the Ulnar Nerve via Subcutaneous Interfascial Anterior Transposition: A Novel Technique.

OBJECTIVE: To compare the clinical outcomes of a newly defined interfascial anterior transposition technique using a pedicled superficial subcutaneous fascial flap with those of simple decompression in patients with cubital tunnel syndrome. METHODS: This retrospective study included 39 patients who had cubital tunnel syndrome and were managed by two different surgical procedures. Twenty-six patients underwent ulnar nerve decompression with interfascial anterior transposition using a pedicled superficial subcutaneous fascial flap, whereas 13 patients underwent simple decompression. Preoperative assessments included clinical and electrodiagnostic evaluations. Disease severity was classified according to the McGowan grading system. Postoperative outcomes were assessed using the visual analog scale (VAS) and Messina's criteria. Preoperative and postoperative VAS scores were compared within and between groups, and the magnitude of VAS improvement was calculated. McGowan grade distributions and postoperative Messina outcomes were also compared between groups. RESULTS: Preoperative VAS scores and McGowan grade distributions were comparable between the interfascial transposition and simple decompression groups (p=0.206 and p=0.900, respectively). Both groups showed significant postoperative reductions in VAS scores (both p<0.001). The mean reduction in VAS score was significantly greater in the interfascial transposition group than in the simple decompression group (5.2 ± 0.7 vs. 4.4 ± 1.3, p=0.035). Postoperative outcomes according to Messina's criteria differed significantly between the groups (p=0.015). Excellent or good outcomes were achieved in 92% of patients in the interfascial anterior transposition group compared with 54% in the simple decompression group. No patient in the interfascial anterior transposition group had a poor outcome, whereas 3 patients (23%) in the simple decompression group were classified as poor. Recurrent symptoms developed in 2 of these patients with poor outcomes, and both subsequently underwent revision surgery. No recurrence or revision surgery was observed in the interfascial anterior transposition group. CONCLUSION: Interfascial anterior transposition using a pedicled superficial subcutaneous fascial flap provides significant clinical improvement in patients with cubital tunnel syndrome and was associated with greater pain reduction and more favorable Messina outcomes than simple decompression in this retrospective cohort. It ensures free nerve gliding, reduces the risk of perineural fibrosis, and provides an additional protective layer, making it suitable for obese and thin patients. Nevertheless, further comparative studies are warranted to validate its long-term efficacy and broader clinical applicability.