Various modifications have been described for the classic Jones transfer (Starr, Brand
and Boyes). All of these techniques require multiple incisions over the dorsal and
volar aspects of the forearm. These time-tested procedures are known for good results,
but the cosmesis is unacceptable for some patients. Single incision technique is a
simpler alternative for achieving better aesthetic results. Although this technique[1] was described more than a decade ago, we feel it is underused. The aim of this article
is to highlight the distinct advantages of the single incision technique over the
conventional technique.
Four patients underwent single incision modified Jones transfer for radial nerve palsy.
Three of the four patients had posttraumatic radial nerve palsy and one had sequalae
of brachial plexus palsy. Flexor carpi radialis (FCR)-based tendon transfer was done
in all patients. Incision was marked over the radial aspect of the forearm, extending
from the junction of the upper and middle thirds of the forearm to just proximal to
the radial styloid process and then curved toward the Lister tubercle. Through this
incision, all the donor and recipient tendons were dissected. The pronator teres (PT)
with a 2 cm periosteal sleeve was dissected to reach the musculotendinous junction
of the extensor carpi radialis brevis. The FCR and palmaris longus (PL) were transected
at the wrist level and dissected proximally. The extensor pollicis longus (EPL) was
rerouted to the radial side of the Lister tubercle after dividing at the musculotendinous
junction. The tendon anastomosis was performed under appropriate tension in a sequential
manner (pronator teres [PT] to extensor carpi radialis brevis [ECRB], FCR to extensor
digitorum communis [EDC], and PL to extensor pollicis longus [EPL]). There was minor
wound dehiscence in the distal suture line which healed spontaneously. Postoperatively,
the patient was given above elbow splint with forearm in pronation, wrist in 45 degrees
of extension, metacarpophalangeal joints in 30-degree flexion, and thumb in maximus
abduction for 4 weeks, followed by monitored physiotherapy. For next 4 weeks, a below
elbow night splint was used in the night. The mean follow-up duration was 10.2 months
(range: 6–16 months). Three of the four patients had excellent and one had had good
outcome based on the Bincaz score.[2] In this technique, the FCR has to transverse across the scar and this could affect
the gliding. None of our patients had this complication due to strict adherence to
physiotherapy. Two of the patients had mild wound dehiscence at the suture line which
healed spontaneously. Although the single scar is comparatively longer than the scars
in conventional technique, it is concealed in most of the day today activities when
compared with the dorsal and ventral forearm scars ([Figs. 1]
[2]). The advantage of the long incision is a wider exposure facilitating dissection,
identification of tendons, and suturing and balancing the tension. Therefore, the
procedure is fast and less tedious.
Fig. 1 Image showing (A) wrist, finger and thumb drop, (B) incision marking, (C) PT to ECRB, FCR to EDC, and PL to EPL tendon anastomosis, (D) sutured wound. Abbreviations: ECRB, extensor carpi radialis brevis; EDC, extensor
digitorum communis; EPL, extensor pollicis longus; FCR, flexor carpi radialis; PL,
palmaris longus; PT, pronator teres.
Fig. 2 Image showing postoperative outcome (A) good wrist and finger extension, (B, C) radial and palmar thumb abduction (D, E), and scarless ventral and dorsal surface of forearm.
