What is Osteotomy with Flap?

Osteotomy with flap is a surgical procedure that involves cutting and repositioning bone (osteotomy) along with the creation of a soft tissue flap to access or support the surgical site. This technique is often used in corrective bone surgery, especially in the hand, wrist, or forearm, where deformities, malunions, or joint misalignment impair function or cause pain.

The flap (typically skin, fascia, or muscle) allows for safe and direct exposure of the surgical area and ensures adequate blood supply for healing.

At Katranji Hand Center, osteotomy with flap is performed using microsurgical precision to restore proper alignment, relieve pain, and improve function—particularly after trauma, congenital deformities, or previous unsuccessful repairs.

Causes

Osteotomy with flap may be recommended for:

• Malunited fractures – bones that healed improperly

• Angular deformities – due to trauma or congenital conditions

• Arthritic joint collapse – where joint realignment is needed

• Carpal or metacarpal shortening

• Improper wrist mechanics or ulnar variance

• Failed prior surgeries

Signs & Symptoms

Conditions requiring this procedure often present with:

• Visible or functional deformity

• Chronic pain at the joint or bone site

• Limited range of motion or weakness

• Mechanical symptoms (clicking, grinding)

• Asymmetry in wrist or finger alignment

Diagnosis

Diagnosis at Katranji Hand Center includes:

• Detailed physical exam – evaluating joint mechanics, alignment, and range of motion

• X-rays – to visualize deformity, joint space, or hardware failure

• CT scans or MRI – to assess complex bony anatomy or adjacent soft tissue

• 3D imaging and planning software – in select cases for precise preoperative mapping

Treatment Options

Surgical Procedure

Performed under regional or general anesthesia, the steps typically include:

1. Flap Creation – A carefully planned incision and soft tissue flap are created to expose the target bone while preserving vascular supply.

2. Osteotomy – The bone is cut (transversely, obliquely, or wedge-shaped) to allow repositioning.

3. Realignment – The bone is shifted, rotated, or lengthened to restore normal anatomy.

4. Internal Fixation – Plates, screws, or pins are placed to stabilize the bone in its new position.

5. Closure – The flap is repositioned and sutured carefully to optimize healing.

The use of a flap also reduces soft tissue tension and helps protect deeper structures during healing.

Postoperative Care

• Immobilization with a splint or cast for several weeks

• Elevation and ice to reduce swelling

• Follow-up imaging to monitor bone healing

• Gradual return to motion with hand therapy

• Full healing typically takes 8 to 12 weeks, with strengthening extending beyond

Associated Risks

Though rare, risks may include:

• Infection or delayed wound healing

• Nonunion or delayed bone healing

• Hardware irritation or failure

• Stiffness or nerve irritation

• Scar sensitivity or flap complications

Prognosis

When performed by skilled surgeons, osteotomy with flap leads to significant improvements in pain, alignment, and function. At Katranji Hand Center, our team combines anatomical expertise, microsurgical precision, and custom rehabilitation plans to ensure optimal outcomes for even the most complex cases.