Soft tissue release and bilobed flap for severe radial longitudinal deficiency

Area of Science:

• Orthopedic surgery
• Pediatric reconstructive surgery
• Hand surgery

Background:

• Radial longitudinal deficiency (RLD) presents significant functional and cosmetic challenges.
• Current treatment algorithms for RLD often involve complex procedures with potential complications.

Purpose of the Study:

• To evaluate the outcomes of treating RLD using soft-tissue release and bilobed flap resurfacing.
• To assess hand position, range of motion, functional results, and radiographic outcomes.

Main Methods:

• Retrospective review of 16 patients (18 wrists) with RLD treated with soft-tissue release and bilobed flap coverage.
• Minimum 3-year follow-up including clinical examination and radiographs.
• Outcome assessment using Pediatric Outcomes Data Collection Instrument (PODCI), Disabilities of the Arm, Shoulder, and Hand (DASH), and visual analogue scale (VAS) scores.

Main Results:

• Mean follow-up of 9.2 years showed improved wrist radial deviation (64° vs. 88° preoperatively).
• Average active wrist flexion-extension arc was 73°, with favorable DASH (27) and PODCI (global 88, happiness 86) scores.
• No physeal growth arrests or need for ulnocarpal arthrodesis observed; patient satisfaction (VAS 1.2) was high.

Conclusions:

• Soft-tissue release and bilobed flap coverage is a viable treatment option for RLD.
• This approach yields useful active motion, good function, and high patient/parent satisfaction.
• The technique offers a lower risk of physeal injury and stiffness compared to other procedures, without compromising future surgical options.