Procedure 25 Flexor Pronator Slide Harry A. Hoyen, Patrick J. Messerschmitt Indications A sustained functional impairment of the spastic upper extremity with a fixed forearm pronation, wrist flexion, and finger flexion deformity. Some retained voluntary motor control of forearm supination, wrist extension, and finger extension must be present. This is more commonly recommended in an established Volkmann forearm contracture. Examination/Imaging Clinical Examination Preoperative examination of the upper limb reveals a fixed contracture of the forearm in pronation with contracture of the wrist and fingers. Grasp and release motions of the hand are impaired owing to the fixed wrist position. In a forearm Volkmann contracture, there is volar deep soft-tissue adhesions and fibrosis. There is often some retained finger and thumb flexion. Surgical Anatomy Pertinent surgical structures include the volar forearm musculature, ulnar nerve, median nerve, brachial artery, and neurovascular structures adjacent to the interosseous membrane. Unlike other contracture release procedures, the proximal anatomy is more relevant in this surgical procedure. The location of the median and ulnar nerves in the proximal forearm is vitally important. Positioning The patient is positioned supine with the arm extended onto a surgical arm board. A nonsterile tourniquet is placed high on the arm before surgical preparation to allow better visualization during the procedure. Dissection in the proximal forearm and elbow may be necessary. Exposures An anteromedial, longitudinal incision at the elbow situated over the medial epicondyle (Fig. 25-1) is made. Superficial dissection includes identification and protection of the medial antebrachial cutaneous nerve. Wide subcutaneous flaps are necessary from the cubital tunnel region to the anterior forearm. FIGURE 25-1 Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: 35: Silicone Metacarpophalangeal Joint Arthroplasty 85: Wrist Denervation 38: Reconstruction for Congenital Thumb Hypoplasia 65: Arthroscopic Treatment for Septic Arthritis 64: Diagnostic Wrist Arthroscopy 89: Total Wrist Fusion Stay updated, free articles. Join our Telegram channel Join Tags: Operative Techniques Hand and Wrist Surgery Mar 5, 2016 | Posted by admin in Hand surgery | Comments Off on 25: Flexor Pronator Slide Full access? Get Clinical Tree
Procedure 25 Flexor Pronator Slide Harry A. Hoyen, Patrick J. Messerschmitt Indications A sustained functional impairment of the spastic upper extremity with a fixed forearm pronation, wrist flexion, and finger flexion deformity. Some retained voluntary motor control of forearm supination, wrist extension, and finger extension must be present. This is more commonly recommended in an established Volkmann forearm contracture. Examination/Imaging Clinical Examination Preoperative examination of the upper limb reveals a fixed contracture of the forearm in pronation with contracture of the wrist and fingers. Grasp and release motions of the hand are impaired owing to the fixed wrist position. In a forearm Volkmann contracture, there is volar deep soft-tissue adhesions and fibrosis. There is often some retained finger and thumb flexion. Surgical Anatomy Pertinent surgical structures include the volar forearm musculature, ulnar nerve, median nerve, brachial artery, and neurovascular structures adjacent to the interosseous membrane. Unlike other contracture release procedures, the proximal anatomy is more relevant in this surgical procedure. The location of the median and ulnar nerves in the proximal forearm is vitally important. Positioning The patient is positioned supine with the arm extended onto a surgical arm board. A nonsterile tourniquet is placed high on the arm before surgical preparation to allow better visualization during the procedure. Dissection in the proximal forearm and elbow may be necessary. Exposures An anteromedial, longitudinal incision at the elbow situated over the medial epicondyle (Fig. 25-1) is made. Superficial dissection includes identification and protection of the medial antebrachial cutaneous nerve. Wide subcutaneous flaps are necessary from the cubital tunnel region to the anterior forearm. FIGURE 25-1 Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: 35: Silicone Metacarpophalangeal Joint Arthroplasty 85: Wrist Denervation 38: Reconstruction for Congenital Thumb Hypoplasia 65: Arthroscopic Treatment for Septic Arthritis 64: Diagnostic Wrist Arthroscopy 89: Total Wrist Fusion Stay updated, free articles. Join our Telegram channel Join Tags: Operative Techniques Hand and Wrist Surgery Mar 5, 2016 | Posted by admin in Hand surgery | Comments Off on 25: Flexor Pronator Slide Full access? Get Clinical Tree
