Congenital| Volume 32, ISSUE 6, P871-875, July 2007

Download started.


Dorsal Rotation Flap for Centralization in Radial Longitudinal Deficiency


      The purpose of this report is to present the results of a dorsal rotation flap for centralization in the treatment of radial longitudinal deficiency.


      All patients surgically treated for radial longitudinal deficiency with a centralization procedure and use of the dorsal rotation flap between 1996 and 2006 were retrospectively reviewed.


      Twenty-one limbs in 15 patients treated with centralization using the dorsal rotation flap were reviewed, with photographs of the scar available for review for 15 limbs in 10 patients. There were no primary wound-healing problems, no hypertrophic scarring, and no color mismatch. In the 15 limbs with available photographs, all scars were rated as good. Use of this incision allowed good surgical access to the necessary structures on the radial and ulnar side of the wrist to allow for centralization.


      The dorsal rotation flap allows rotation of the skin in a radial direction while the hand and carpus are rotated in an ulnar direction; the redundant skin on the ulnar side of the wrist is rotated to compensate for the shortage of skin on the radial side of the wrist. This report describes use of the dorsal rotation flap with no complications attributable to the surgical approach.

      Type of study/level of evidence

      Therapeutic IV.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Allison D.M.
        The spectrum of radial longitudinal deficiency.
        J Hand Surg. 2000; 25A: 984-985
        • James M.A.
        • McCarroll Jr, H.R.
        • Manske P.R.
        The spectrum of radial longitudinal deficiency: a modified classification.
        J Hand Surg. 1999; 24A: 1145-1155
        • Urban M.A.
        • Osterman A.L.
        Management of radial dysplasia.
        Hand Clin. 1990; 6: 589-605
        • Sayre R.H.
        A contribution to the study of radial club hand.
        Trans Am Orthop Assoc. 1893; 6: 208-216
        • Bora F.W.
        • Osterman A.L.
        • Kaneda R.R.
        • Esterhai J.
        Radial club hand deformity: long-term follow-up.
        J Bone Joint Surg. 1981; 69A: 741-745
        • Lamb D.W.
        Radial club hand: a continuing study of sixty-eight patients with one hundred and seventeen club hands.
        J Bone Joint Surg. 1977; 59A: 1-13
        • Lourie G.M.
        • Lins R.E.
        Radial longitudinal deficiency: a review and update.
        Hand Clin. 1998; 14: 85-99
        • Manske P.R.
        • McCarroll H.R.
        • Swanson K.
        Centralization of the radial club hand: an ulnar surgical approach.
        J Hand Surg [Am]. 1981; 6: 423-433
        • Tonkin M.A.
        • Nanchahal J.
        An approach to the management of radial longitudinal deficiency.
        Ann Acad Med Singapore. 1995; 24: 101-107
        • Buck-Gramcko D.
        Radialization as a new treatment for radial club hand.
        J Hand Surg. 1985; 10A: 964-968
        • Mow C.S.
        • Woolson S.T.
        • Ngarmukos S.G.
        • Park E.H.
        • Lorenz H.P.
        Comparison of scars from total hip replacements done with a standard or a mini-incision.
        Clin Orthop Relat Res. 2005; 441: 80-85
        • Watson H.K.
        • Beebe R.D.
        • Cruz N.I.
        A centralization procedure for radial clubhand.
        J Hand Surg. 1984; 9A: 541-547
        • Tonkin M.
        Radial longitudinal deficiency (radial dysplasia, radial clubhand).
        in: Green D.P. Hotchkiss R.N. Pederson W.C. Green’s operative hand surgery. 4th ed. Churchill Livingston, New York1999: 344-358
      1. Flatt AE. The care of congenital hand anomalies. In: ed. St 1994 Quality Medical Publishing Louis: 366–410.

        • Evans D.M.
        • Gateley D.R.
        • Lewis J.S.
        The use of a bilobed flap in the correction of radial club hand.
        J Hand Surg [Br]. 1995; 20B: 333-337
        • Pilz S.M.
        • Muradin M.S.
        • Van der Meulen J.J.
        • Hovius S.E.
        Evaluation of five different incisions for correction of radial dysplasia.
        J Hand Surg. 1998; 23B: 183-185