PMC8259861_01
The initial full thickness dorsoulnar lesion of the right forearm.
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The patient was noted to have a large full-thickness right dorsal hand and dorsoulnar forearm lesion measuring 4.5 cm x 6.5 cm (Figure 1).
Preoperative photographs of the right forearm after scar release and two z-plasties with persistent severe contracture.
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Improvement was temporary and by 9 months of age, the patient developed ulnar deviation from a lack of growth at the ulna and restriction to wrist and finger extension likely secondary to scarring and adhesions (Figure 2).
Preoperative markings for a left latissimus dorsi flap with skin paddle.
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After a thorough discussion with the parents, the patient underwent complete scar excision, extensive tenolysis to the entire extensor compartment, and coverage with a latissimus dorsi free flap with a 9 x 5 cm split-thickness skin graft (Figures 3-6).
Intra-operative photograph of the latissimus dorsi flap after dissection and before anastomosis and inset.
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After a thorough discussion with the parents, the patient underwent complete scar excision, extensive tenolysis to the entire extensor compartment, and coverage with a latissimus dorsi free flap with a 9 x 5 cm split-thickness skin graft (Figures 3-6).
Intra-operative photograph after extensor tenolysis and prior to final flap inset.
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After a thorough discussion with the parents, the patient underwent complete scar excision, extensive tenolysis to the entire extensor compartment, and coverage with a latissimus dorsi free flap with a 9 x 5 cm split-thickness skin graft (Figures 3-6).
Intra-operative photograph of the final inset of the latissimus dorsi flap with a skin paddle and split thickness skin graft.
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F0006
After a thorough discussion with the parents, the patient underwent complete scar excision, extensive tenolysis to the entire extensor compartment, and coverage with a latissimus dorsi free flap with a 9 x 5 cm split-thickness skin graft (Figures 3-6).
Long-term follow-up at age nine when the patient presented for flap revision with z-plasties and debulking.
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The patient required several subsequent surgeries including distraction lengthening of the ulna at age 4, followed by a palmaris longus to extensor pollicis longus tendon transfer and z-plasty scar revision at age 6, and finally a flap debulking procedure at age 9 (Figure 7).