The second set of sutures are tied, securing the reflected extensor digitorum communis and mobile wad beneath the superficial flexor group, completing the myodesis. Figure-of-eight non-absorbable sutures are placed in the myofascial layer of the FDS and extensor muscles to contour the muscle mass allowing for a tension free closure. Bulky muscle not directly covering the bone ends or directly involved in the myoplasty should be sharply derbrided to allow for a tension free repair on the skin.
The skin flaps are approximated using modified Algower-Donati stitches using monofilament suture over a closed, superficial tissue drain. This suture method has been shown to have improved wound tissue edge oxygenation (see discussion.)
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