Bobby jabberin this is our approach for
00:03
extensiveness appropriate opponents
00:06
plasti here at the University of
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Virginia this individual is a young girl
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who has hypoplastic thumb for which we
00:14
performed a four flap a z-plasty to
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deepen the first webspace and the
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initial portion of this procedure second
00:20
portion of this procedure was to improve
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opposition strength the e IP tendon was
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marked the course of the eye p10 was
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marked as was the insertion point along
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the thumb the vector of the EIP and a
00:37
reciprocal incision along the ulnar
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aspect of the risk to pass the IP tendon
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the AE IP can be used safely as there is
00:45
also an EDC to the index finger so dual
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extension of the index finger careful
00:50
dissection was performed over the level
00:52
of the mCP joint and retractors are used
00:55
to expose the sagittal ban the EIP is
00:58
identified as the owner of the two
01:00
tendons as shown here and once the EIP
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is identified it is a dissection is
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carried out distally incorporating a
01:16
portion of the sagittal band if a
01:18
sagittal hood if needed a suture limb is
01:21
placed prior to cutting the tendon
01:24
distally so that it can be used as a
01:29
retraction stitch as well as to identify
01:31
it once you cut the the tendon the
01:33
tendon is cut as distal as possible and
01:36
the remnant of the EIP is then suture to
01:40
the adjacent EDC to ensure that there's
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no extensor lag as shown here
01:54
next a more proximal incision is planned
01:59
and made to retrieve the EIP tendon to
02:05
redirect it along the owner aspect of
02:09
the of the wrist sometimes it is
02:16
difficult to to retrieve the EIP tendon
02:20
so any factual connections should be
02:22
released through the initial incision at
02:24
the mCP joint a more proximal incision
02:28
is made just proximal to the extensor
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retinaculum sometimes several incisions
02:34
may be necessary the IP tendon is
02:37
identified it transfer it courses owner
02:40
to radial and is often the tendon which
02:43
has the most distal muscle belly through
02:47
the proximal incision that the tendon is
02:49
retrieved the owner side incision
02:52
approximately at the level of the piece
02:54
of form is created careful dissection
02:55
should be performed here to prevent
02:57
injury to the dorsal owner cutaneous
02:59
nerve a hemostat can be used to tunnel
03:05
the subcutaneous tissue and the tendon
03:07
retrieved a tendon passer can then be
03:11
used to tunnel across the palm the
03:14
insertion site is incision is insertion
03:19
site incision is made and a tendon
03:21
passer or tunnel can be used to tunnel
03:25
under the palm superficial to the
03:27
transverse carpal ligament this is this
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should be a very superficial tunnel and
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the tendon can then be passed and
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inserted with the tenon to the thumb in
03:38
opposition to the opponent's tendon and
03:45
other thenar tendons such that the ten
03:50
the thumb is placed is is in a position
03:53
of opposition at the completion of the
03:57
tendon insertion the first stitch should
04:00
be a a tensioning stitch to make sure
04:03
that the thumb is an appropriate
04:05
position the hemostasis is obtained the
04:07
wound is closed and the position patient
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then kept splinted in a position of
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opposition