Published on 18/04/2015 by admin
Filed under Surgery
Last modified 18/04/2015
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Procedure 25 Flexor Pronator Slide
Harry A. Hoyen, Patrick J. Messerschmitt
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.
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.
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.
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.
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
Operative Techniques Hand and Wrist Surgery
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