title: Soft tissue release and bilobed flap for severe radial longitudinal deficiency.
abstract: OBJECTIVE
  To report the hand position, range of motion, functional results, and radiographic outcomes associated with treating radial longitudinal deficiency with release of constricting or deforming soft tissue and resurfacing of the radial skin deficiency with a bilobed flap.
  
  
  METHODS
  We recalled and reviewed patients with at least a 3-year follow-up who had undergone soft-tissue release and coverage with a bilobed flap. The study group consisted of 16 patients and 18 wrists. All patients underwent follow-up examination and radiographs. Outcome measures using Pediatric Outcomes Data Collection Instrument (PODCI), Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analogue scale (VAS) scores were recorded.
  
  
  RESULTS
  At a mean of 9.2 years follow-up, the average final resting wrist radial deviation angle was 64° compared with 88° preoperatively. The average active wrist flexion-extension arc was 73°. Average DASH score was 27 (range, 5-54). PODCI global was 88 (range, 75-97), PODCI happiness was 86 (range, 70-100), and VAS overall satisfaction (range, 0-10) was 1.2 (range, 0-8). At final follow-up, no physeal growth arrests were noted on radiographs, and no patients to date have required ulnocarpal arthrodesis.
  
  
  CONCLUSIONS
  Soft-tissue release and coverage with a bilobed flap should be considered in the treatment algorithm for patients with radial longitudinal deficiency. Outcome measures show that these patients maintain useful active motion, and along with their parents, are satisfied with both the appearance and function. Some recurrence of radial deviation was noted, which was similar to results previously reported following centralization/radialization procedures, although with a lower inherent risk of both physeal injury to the ulna and stiffness. In addition, potential future procedures are not compromised by this surgical approach.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX.
authors.forename: Carley
authors.initials: C
authors.lastname: Vuillermin
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX.
authors.forename: Lindley
authors.initials: L
authors.lastname: Wall
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX.
authors.forename: Janith
authors.initials: J
authors.lastname: Mills
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX.
authors.forename: Lesley
authors.initials: L
authors.lastname: Wheeler
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX.
authors.forename: Ryan
authors.initials: R
authors.lastname: Rose
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX.
authors.forename: Marybeth
authors.initials: M
authors.lastname: Ezaki
authors.affiliation: Texas Scottish Rite Hospital for Children, Dallas, TX. Electronic address: Scott.Oishi@tsrh.org.
authors.forename: Scott
authors.initials: S
authors.lastname: Oishi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006228:Hand Deformities, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D011884:Radius / Q000002:abnormalities*; D020127:Recovery of Function; D013524:Surgical Flaps; D016896:Treatment Outcome; D014955:Wrist Joint / Q000002:abnormalities* / Q000601:surgery*
keywords: Radial longitudinal deficiency; bilobed flap; radial dysplasia