| There are many variations on the procedure of soft tissue basal joint arthroplasty. In this case, the abductor pollicis longus tendon is split with a custom tendon stripper and used as a distally based graft for ligament reconstruction and interposition. |
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| Preoperative films. |
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| Incision from the thumb metacarpal base to the radial styloid. |
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| Here, a custom tendon stripper allows the procedure through this single incision. |
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| The stripper was fashioned from the handle of a tonsil snare and a length of a K wire bent into a loop at the end. The free end of the wire can be withdrawn into the shaft of the snare, closing the loop. |
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| The stripper is passed around the ulnar/dorsal half of the abductor tendon. |
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| closed, |
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| and advanced while gentle traction is placed on the section of tendon being harvested. |
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| The distally based tendon slip separates proximally at the musculotendinous junction. |
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| Trapeziectomy is facilitated with an angled scalpel blade. |
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| This slip is passed around the flexor carpi radialis, around the intact APL, then pleated into a deep spacer. |
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| Closure. |
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