The bilobed flap - a better option for soft tissue release in the management of Radial Club Hand.

OBJECTIVE: To establish that the bilobed flap as soft tissue release component for the radial club hand is superior to the z-plasty technique in type III and IV radial club hands.

METHODS: This study was conducted at the Shifa International Hospital, Islamabad, Pakistan, from 2009 to 2015, and comprised patients with radial club hands operated by a single consultant plastic surgeon. Soft tissue release was performed at 08 months. The extremity was then casted for 08 weeks and kept in a long-arm cast for 3 to 6 months.

RESULTS: Twelve radial club hands of 9 patients treated successfully during the study period showed good to excellent results. Z-plasty was used on the radial side to correct the soft tissue deficiency in 5(42%) hands, and a bilobed flap in 7(58%) hands for soft tissue rearrangement on the radial side. Of all hands, 1(8.3%) z-plasty flap developed partial flap necrosis and 1(8.3%) each developed infection and needed implant (Kirschner wire removal), which were dealt with efficiently with no long-term sequelae.

CONCLUSIONS: The bilobed flap was found to be superior to the z-plastytechnique since the flap had better predictability and no tissue was wasted.