Figure 3: Clinical photographs depicting elements of soft-tissue release via a volar bilobed flap. (a) Pre-operative resting position, depicting radial deviation of the wrist and a hypoplastic thumb. (b) After pre-operative stretching and splinting, the wrist may be passively stretched to neutral position. (c, d, e) Intra-operative photographs depicting the (c) radial, (d) volar, and (e) ulnar aspects of the incision. A volar approach was chosen given the aesthetic advantages of leaving the dorsal wrist free of scars. (f) Intra-operative photograph after flap elevation, allowing for access to the musculotendinous units for release and/or transfer. Note the soft-tissues about the distal ulnar physis are carefully preserved. (g) Intra-operative depiction of flap rotation, providing tissue to the previously taught radial wrist. (h, i) Clinical photographs after wound closure, demonstrating improved alignment of the wrist. (j) At 3 months post-operatively, incisions are well healed, flaps remain viable, and the wrist is supple with improved resting alignment. (All images courtesy of Children’s Orthopaedic Surgery Foundation, copyright 2016)
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