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Without the
ability to bring the thumb into
opposition, hand function is greatly
impaired. The first web space can
be injured by trauma or disease or be
affected by a congenital
deficiency. Contracture of the
first web can be classified as mild,
moderate or severe. The usual
etiology of severe contracture is a
traumatic injury to the hand, sometimes
of the thumb, extending into the
web. Contracture can be a result
of three different diseased tissue
components
-
Skin
-
Fascia
and Muscle
-
Joint
Contracture
confined only to the skin can often be
treated with a local flap, such as a
four-flap z-plasty or a dorsal
transposition flap. However, if
the contracture is a result of
significant skin loss, or there is
fascial, muscle or joint involvement,
first web release with microvascular
transplantation of a fasciocutaneous
flap provides an excellent solution to
this problem.
Clinical
Example
 This
patient suffered a devastating crush
injury to his right hand that required
several reconstructive surgical
procedures including revascularization.
The crush resulted in scarring and
contracture of the first web
space. Skin, fascia, muscle and
the basilar thumb joint were all
affected. He could not grasp large
objects in his fist and could not bring
his thumb into opposition.
The first
web space was surgically released.
Because of the severity of the scar,
release of the web and the
carpometacarpal joint left a soft tissue
defect that exposed both bone and
tendon. A microvascular transplant
of the anterolateral thigh was chosen to
close the defect.
The patient
is pictured below at approximately six
months after surgery. His web
space is loose and he is able to keep
his thumb in opposition. He can
grasp a two by four block easily.
Hand function is vastly improved over
his preoperative state.
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