Classification and Reconstructive Strategies of First Web Space Contracture

ABSTRACT

Adequate first web space is essential for web space expansion, thumb abduction, and a wide range of thumb mobility and hand function activities. First web space contracture is caused by burns, trauma, infection, arthritis, ischemia, paralysis, spastic conditions, improper splinting, Dupuytren's contracture, or congenital anomaly. We have treated 18 cases of first web space contracture from Nov. 1, 1996 to Apr. 30, 2000 using 23 various flaps. Four measurements such as maximal abduction angle, maximal abduction distance, radial abduction angle, and palmar abduction angle were examined preoperatively and postoperatively. We have classified first web space contracture as mild, moderate, or severe depending upon the magnitude of contracture and scarring of the first web contents (skin, fascia, muscle and joint capsule). We have performed hree Z-plasty, three double opposing Z-plasty, and two 4 flap Z-plasty in 6 mild contracture. We have performed two Z-plasty and F.T.S.G, two dorsal rectangular flap and F.T.S.G, two F.T.S.G, and two S.T.S.G in 5 moderate contracture. We have performed two distant flaps and five free flaps in 7 severe contracture. Periods of follow-up were from 12 months to 35 months with an average of 15 months. Every patient was analyzed by the ratio of postoperative measurements to preoperative measurements. The mean ratios of mild, moderate, and severe contracture were 1.33, 1.28, and 1.38 respectively. Although first web space contracture was severe, its ratio was more improved than that of mild or moderate contracture because of complete release and abundant soft tissue coverage such as first web space free flap. The proper methods of first web space contracture release in accordance with the classification allowed to achieve excellent results.