Operative Technique

A, The patient is placed in a lateral position. A midline incision is made on the posterior aspect of the arm, beginning in the middle half and extending distally to a point lateral to the olecranon process; the incision is then carried over the subcutaneous surface of the shaft of the ulna for a distance of 5 cm. The subcutaneous tissue is divided, and the wound flaps are mobilized.

B, The ulnar nerve is identified and mobilized medially to protect it from injury. The intermuscular septum is exposed laterally.

C, Left, The ulnar nerve is mobilized and transferred anteriorly. Right, The triceps muscle is lengthened in a W fashion, leaving a long proximal tongue.

D, The triceps muscle is freed and mobilized proximally as far as its nerve supply permits. The motor branches of the radial nerve to the triceps enter the muscle in the interval between the lateral and medial heads as the radial nerve enters the musculospiral groove. The distal portion of the detached triceps is then sutured to itself to form a tube.

E and F, Through a curvilinear incision in the antecubital fossa, the interval between the brachioradialis and pronator teres is developed.

G, With an Ober tendon passer, the triceps tendon is passed into the anterior wound subcutaneously, superficial to the radial nerve.

H, With the elbow in 90 degrees of flexion and the forearm in full supination, the triceps tendon is sutured to the biceps tendon or anchored to the radial tuberosity by a suture passed through a drill hole. The wound is closed in a routine fashion. An above-elbow cast is applied, with the elbow in 90 degrees of flexion and full supination.