Here is the op note: THANKS

1. Radial nerve tendon transfers pronator teres to ECRB
2. Flexor carpi radialis to extensor digitorum of index, long, ring and small fingers
3.Palmaris longus to abductor pollicis longus

A large lazy S incision was made starting dorsally in the midline over the wrist extending proximally for 4 to 5 cm and then bending radially across the radial boder of the forearm to the mid volar line of the forearm extending proimally an additional 6 cm. The incision was taken sharply through skin and subdermal tissue. On the flexor side the donor tendons of the palmaris longus, and FCR were identified and transected distallyl They were fully mobilizedThe brachioradialis was elevated. The pronator teres was identified attaching to the radius. This donor tendon was harvested along with an approximately 4cm strip of periosteum to extend the tendon.

Attention was then turned to the recipient side. A transverse incision was made just proximal to the extensor retinaculum and tehn this was extended in a T type fashion to expose the dorsal tendons. The extensor carpi radialis brevis tendon was identified. The extensor pollicis longus tendon was identified and transected at the musculocutaneous junction. A small incision was made distally at the extensor retinaculum nd the tendon was pulled ou tof the third dorsal compartment and laid along the radial aspect of the radius in line with the radius. Finally the extensor digitorum comminus tendon to the index, long and small fingers were identified proximal to to the retinaculum. With the fingers in normal cascade th finger extensor tendons were all sutured together with 2-0 mersilene suture. Two horizontal mattress sutures were placed. After this the flexor carpi radialis tendon was mobilized over top of the brachioradialis but underneath the cutaneous nerves. Using a pulvertaft weave the tendon was woven through the tendon of the index extensor digitorum comminus, long extensor digitorum comminus, ring extensor digitorum comminus and small extensor digitorum comminus. It was tensioned so the fingers were in extension with the wrist extended. Appropriate tension was placed on the tendon weave and it was sutured in place with 2-0 mersilene suture. With the wrist in full extension I could fully flex the fingers however with the wrist flexion good tenodesis was present. The remainder of the FCR tendon was then woven in a pulvertaft weave back again through each of the extensor digitorum comminus tendons and then sewn back on top of itself.

The EPL tendon and the palmaris graft were then mobilized again using a pulvertaft weave the palmaris longus muscle was woven through EPL tendon. Appropriate tension was set so that the thumb could be flexed into the palm with the wrist extended but showed good tenodesis. An additional 2 pulvertaft weaves were performed. The entire thing was sewn together with 3-0 mersilene suture The wrist was maximally extended and the pronator teres was transferred to the extensor carpi radialis brevis. The maximum tension was placed on the wrist extensor. This was woven with two additional pulvertaft weaves and sewn in place with multiple 3-0 mersilene sutures. The pronator was sewn additional side to side into the ECRB proximal to the pulvertaft weave. ........