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this is Bobby Chopra and this is a video
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showing our 4-flat z-plasty webspace
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deepening procedure this is an
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individual with AI PO plastic thumb who
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had a first webspace contracture that
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was limiting her ability to abduct and
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her thumb and grasp objects we planned a
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four five flap z-plasty in conjunction
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with the EIP opponents plasti to help
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improve her function a decision was made
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in the first web space with symmetric
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four flaps one at 90 degrees along the
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dorsal and bowler aspect of the of the
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crease and then an additional one at 45
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degrees in a reciprocal fashion as shown
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here this is a standard for flap
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z-plasty and we made sure that each of
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the limbs were of equal a size to ensure
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adequate deepening of the first webspace
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incision was made carefully care was
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taken to prevent to prevent manipulating
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the tips of the incision as this can
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lead to tip necrosis but careful
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dissection was performed full thickness
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with care to prevent injury to any
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underlying nerve structures these flaps
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were elevated and until adequate they
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were released adequately so that they
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can be transposed careful dissection is
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performed and as you can see the flaps
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are very carefully handled blood
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dissection was performed to ensure that
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all flaps were released and then by AB
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ducting the thumb the flaps should fall
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into their appropriate places if the
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incision is planned a pro
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appropriately with equal size limbs
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corner stitches are used to inset each
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of the flaps as shown here and in this
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manner and excellent deepening is
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obtained of the first web space this is
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a very functional procedure if if done
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appropriately and does take adequate it
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does take optimal preoperative planning
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so that appropriate an appropriate flap
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is created once the procedures completed
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dressing is applied