Van Heest technique. A, Incision for dorsal rotation flap, extending from ulnar midlateral border of wrist, transversely across dorsum of wrist in Langer’s lines and to radial midlateral border of wrist. B, Dorsal rotation flap allowing for rotation of skin in radial direction while hand and carpus are rotated ulnarly. Redundant skin on ulnar side of wrist rotated to compensate for shortage of skin on radial side. Flap naturally falls into place as hand and carpus are rotated ulnarly for centralization.