35 Scapholunate Reconstruction with Dorsal Capsular Flap (Blatt Procedure)

• Dorsal midline incision
• Release extensor pollicis longus (EPL) and retract radially; open and retract the fourth extensor compartment in an ulnar direction.
• Design and mobilize proximally based capsular flap with distal margin at the STT joint. The width of the flap is 10 to 15 mm (Fig. 35-1).
• If dorsal portion of SL ligament is substantial enough to repair, place suture anchors at site of ligament avulsion. If the ligament is not repairable, debride the remnants.
• Place a 1 to 2 cm, V-shaped incision on the radial aspect of the wrist (Fig. 35-2).
• Identify and protect branches of the radial sensory nerve.
• Place two 0.045 in. pins into the radial aspect of the scaphoid, one directed toward the SL joint, the second toward the scaphocapitate (SC) joint.
• Place two additional 0.045 in. pins in the dorsal aspect of the scaphoid and lunate to use as joysticks.
• Reduce the SL joint under fluoroscopy and advance the SL and SC pins (Fig. 35-3).
• Remove joystick pins.
• Create trough on dorsal aspect of distal pole of scaphoid, distal to dorsal ridge.
• Place suture anchors in trough.
• Suture capsule to trough with wrist in slight extension (Fig. 35-4).
• Close capsule.
• Leave EPL free in subcutaneous tissues. Repair fourth compartment and close skin.
• Cut pins beneath skin.

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