Surgical management of radial longitudinal deficiency (RLD) aimed to correct the wrist radial deviation by centralizing the carpus upon the ulnar distal end, conjointly with soft tissue structures balancing around the wrist, whilst preserving the distal ulnar physis growth potential. Although, several skin incisions were used for centralization procedure, but few of them dealt with the issue of substantial skin tension radially with available redundant skin ulnarly, and the difficulty for full access of the radio-volar aspect for fully release the tethering structures.

Nineteen wrists in 13 patients with RLD of Bayne and Klug type IV, were operated on by centralization using circumferential rotational flap between 2008 and 2017. The average age at the time of centralization was 18.5 months. Follow-up evaluation was done at 3 months intervals, average follow-up was 42 months. Patients were evaluated at postoperative follow-up according to the clinical appearance of scar, wrist stability, and radiological parameters on preoperative and postoperative radiographs.

Encouraging primary wound healing, and on the latest follow-up; a smooth satisfactory wrist contour was restored, significant improvement of the hand forearm angle (HFA) and hand forearm position (HFP) compared with the preoperative measures, and a significant ulna growth continued postoperatively signifying no distal ulnar physis injury occurred. Parents were satisfied with the resulted esthetics and function of the hand, which would be attributed to the improved stability of the carpo-ulnar pseudo-articulation.

This flap allowed excellent access to the radio-volar aspect of the wrist, and facilitates rotation of the ulnar redundant skin in a radio-volar direction, whilst rotating the distal hand and carpus into ulnar-sided direction, provided additional skin to the radial aspect. It was safely used for centralization procedure in this study preserving the growth potential of the distal ulna without memorable complications attributed to the flap, leaving a smooth satisfactory contoured wrist.

A circumferential rotational flap was safely used for centralization procedure in this study, provided additional skin on the radial aspect and take up the slack on the ulnar aspect and gave excellent access to the wrist and surrounding soft tissue structures without recorded complications attributed to the flap.