Reconstruction of a postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve-Kapandji procedure—A case report

Authors

  • Ricardo Horta,

    Corresponding author
    1. Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, Porto, Portugal
    2. Alameda Professor Hernâni Monteiro, Porto, Portugal
    • Correspondence Ricardo Horta, Avenida Menéres, nº 234, Bloco 2, 4º Frente Esquerdo, 4450-189, Matosinhos Sul- Porto, Portugal. Email: ricardojmhorta@gmail.com

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  • Ricardo Nascimento,

    1. Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, Porto, Portugal
    2. Alameda Professor Hernâni Monteiro, Porto, Portugal
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  • Alvaro Silva,

    1. Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, Porto, Portugal
    2. Alameda Professor Hernâni Monteiro, Porto, Portugal
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  • Rui Pinto,

    1. Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
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  • Pedro Negrão,

    1. Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
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  • Ricardo São-Simão,

    1. Orthopedic Department, Centro Hospitalar São João, Faculty of Medicine, University of Porto, Porto, Portugal
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  • Jorge Carvalho,

    1. Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, Porto, Portugal
    2. Alameda Professor Hernâni Monteiro, Porto, Portugal
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  • Marta Santos Silva,

    1. Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, Porto, Portugal
    2. Alameda Professor Hernâni Monteiro, Porto, Portugal
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  • Jose Amarante

    1. Department of Plastic, Reconstructive and Maxillo-Facial Surgery, and Burn Unity, Centro Hospitalar De São João, Faculty of Medicine, University of Porto, Porto, Portugal
    2. Alameda Professor Hernâni Monteiro, Porto, Portugal
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Abstract

Radial club hand may be congenital or acquired; radial deviation of the hand is usually found, associated with palmar flexion–pronation and treatment of severe forms of radial club hand is often difficult. Here we present a case of reconstruction of a severe postraumatic radial club hand with a free fibular osteoseptocutaneous flap and Sauve–Kapandji procedure in a 28-year-old man. The patient had a radial deviation of the wrist and right upper limb shortening as a result of an infected pseudarthrosis of the radius. This deformity was reconstructed with a free fibular osteoseptocutaneous flap associated to arthrodesis of the distal radioulnar joint and an ulnar resection osteotomy proximal to the arthrodesis in order to restore rotation of the forearm (Sauvé–Kapandji procedure). The flap fully survived and no complications were seen in the early postoperative period at both recipient and donor sites. Radius alignment was restored. At 5-month follow-up, the skeleton was healed. There was minimal osteopenia at the distal radial segment. Wrist extension was 48 degrees, flexion 24 degrees, and pronation–supination was 58–0–48 degrees, with full finger flexion. The patient could hold a 4 kg dumbbell with the elbow flexed without discomfort. His DASH score—Disabilities of the Arm, Shoulder, and Hand Questionnaire was 15.83. Combined free fibular osteoseptocutaneous flap and Sauve–Kapandji procedure may be considered in severe forms of postraumatic radial club hand, however, further data are necessary. © 2016 Wiley Periodicals, Inc. Microsurgery 36:593–597, 2016.

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