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Circumferential rotational flap for centralization in radial longitudinal deficiency

Background The goals of surgical intervention for correction of radial longitudinal deficiency are to correct the radial deviation deformity of the wrist by centralizing the carpus on the distal end of the ulna, concomitant with balancing the soft tissue structures at the wrist, while preserving the growth potential of the distal ulna. Several skin incisions have been used; however, few of these procedures handled the problem of significant skin tension on the radial side with excessive skin available on the ulnar side, and the difficult full access to fully release the tethering structures on the radio-volar side. Patients and methods A total of 19 wrists in 13 patients with radial longitudinal deficiency of Bayne and Klug type IV were operated on by centralization using circumferential rotational flap between 2008 and 2016. The average age at the time of centralization was 18.5 months. Follow-up evaluation was done at 3-month intervals, and average follow-up was 42 months. Patients were evaluated at postoperative follow-up according to the clinical appearance of scar, wrist stability, and radiological parameters on preoperative and postoperative radiographs. Results There were no difficulties related to access, no part of any flap was lost, and there were no primary wound healing problems. Evaluation of the scar revealed no gross mismatch of the color, no proud or keloid contours, and no distortion, and good contour was restored. The subjective overall appearance was good, and the growth potential of the distal ulna was preserved. Conclusion A circumferential rotational flap was safely used for centralization procedure in this study. It provided additional skin on the radial aspect and took up the slack on the ulnar aspect and gave excellent access to the wrist and surrounding soft tissue structures without notable complications attributable to the flap.