There seems to be an advantage to covering the plate with the pronator quadratus (PQ) in order to interpose the muscle between the plate and the flexor tendons. During the initial dissection, most surgeons incise the PQ distally at the edge of the muscle fibers. This line is referred to as the PQ line (see footnote 1). After plate placement, most surgeons repair the PQ muscle. However, the thinness of the fascia of the muscle makes this an exercise in futility, as the sutures typically rip out before the next layer is closed. One technique that has proven to be quite secure is to release the PQ during the original dissection not along the margin of the muscular fibers (the PQ line), but 1-2 mm beyond the PQ line, into the fibrous tissue proximal to the volar capsule. This fibrous tissue, termed the fibrous transition zone (see footnote 1), has been determined in cadaveric dissections not to be part of the mobile volar wrist capsule (comprised of the radioscaphoid, radiocapitate, long radiolunate, and short radiolunate ligaments), but to be immobile and attached to the distal margin of the radius. It is felt that incising the fibrous transition zone should not add unnecessarily to wrist capsular scarring or wrist joint stiffness. Continue the dissection radially 1-2 mm into the fibrous tissue at the base of the first dorsal compartment. If this is done, there will be a 1-2 mm thick, strong margin along the edge of the PQ muscle. This margin will securely hold the sutures and the PQ will remain in place, serving as an interpositional layer between the plate and the flexor tendons.
Polyps may be treated with medical, surgical, or behavioral intervention. Surgical intervention involves removing the polyp from the vocal fold. This approach is only used when the growth(s) are very large, or have existed for an extended amount of time. In children, surgical intervention is rare. Existing medical problems may be treated in an effort to reduce the strain and negative impact on the vocal cords. This could include treatment for gastrointestinal reflux disease, allergies, and thyroid problems. Intervention to stop smoking and reduce stress may also be needed. Most people receive behavioral intervention, or vocal therapy, from an SLP. This might involve teaching good vocal hygiene, and reducing or stopping vocal abuse behaviors. Direct voice treatments may be used to alter pitch, loudness, or breathe support to promote good voicing.