Radial Club Hand

1. The use of the Evans Bilobed Flap in
the management of Radial Club Hand
The Red Cross Childrens Hospital
Experience 2010-2014
Cape Town
Dr Steve Carter

2. History
Incisions used for Centralization
• Lamb(1972) Gramcko(1985) Large S shaped incision
• Manske(1981) Transverse ulna approach
• Watson(1984) Bayne and Klug(1987) Radial based Z
plasties
• Red Cross Hospital(2003-2010) Combination of
above

3. Requirements for Exposure
• Need complete Radial and Ulna exposure
• Need Dorsal and Volar exposure
• Closure
• ?Centralization ? Radialization
• Disarticulation through 270 degrees with
preservation of the Ulna Vascular Corridor
• The Evans Bilobed Flap JHS (1995)20B:3:333-337

4. The Evans Bilobed Flap

5. The Evans Bilobed Flap

6. The Evans Bilobed Flap

7. The Evans Bilobed Flap

8. The Evans Bilobed Flap

9. The Evans Bilobed Flap

10. Results
Name DOB Gender Bayne Type Age at op Side Syndrome Complications
TN 05/01/11 Male 4 2 Right Nil Nil
HB 03/02/12 Male 4 1 Left TAR Epidermolysis
LD 02/08/07 Male 4 3
3 and half
Bilateral VATER Nil
ES 01/06/11 Female 4 3 Right Nil Nil
ET 06/09/11 Male 4 1 Right Nil Epidermolysis
LA 02/08/13 Male 4 1 Right Nil Nil
DS 05/08/08 Male 4 2
3
Bilateral Nil Nil

11. Conclusion
• Provides excellent exposure, Radial/Ulna as well as
Volar/Dorsal
• Allows for 1 stage correction
• No major complications
• No Flap loss
• No revision surgery
• Provides good soft tissue cover away from the area
of subsequent pollicization
• 20% incidence minor complication- Epidermolysis