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Bilobed Flap for Radial Longitudinal Deficiency(RLD): Clinical and Radiographic Outcomes
Scott Oishi, MD; Lindley B. Wall, MD; Marybeth Ezaki
Texas Scottish Rite Hospital for Children, Dallas, TX

The optimum treatment of the severe radially deviated wrist in RLD has yet to be determined. Centralization or radialization, with or without distraction, is the procedure that is most commonly utilized, despite having risks of significant recurrence and ulnar physis injury. We have utilized the bilobed flap with soft-tissue release as an alternative procedure and will report our outcomes. Our study group consisted of 14 wrists in 11 patients with an average follow-up of 9 years, 10 months (3 years to 16 years). All patients underwent bilobed flap with release of tight radial structures. Careful attention to not disturbing the ulnar physis was an integral part of the procedure. Follow-up revealed all patients to have some active wrist motion. Average DASH score was 30 (5-55), PODCI Global was 86 (75-98), and PODCI Happiness was 84 (55-100). No physeal injuries were noted in follow-up radiographs, and no patients required subsequent arthrodesis. In conclusion, we feel that the bilobed flap is a reliable procedure which should be considered in the treatment algorithm for patients with RLD. Outcome measures show that patients use the extremity well after the procedure, and are very satisfied with the result. In addition, it preserves wrist motion with no injury to the ulnar physis.


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