الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Adduction contracture of the thumb predominantly affects the movements at the trapeziometacarpal joint, rendering the thumb ineffective in opposition and thereby destroying the essential element of grasp and pinch and proper primary management can avoid contracture development. (38)
The aim of this work was to evaluate the versatility of using a dorsal rectangular and two volar triangular flaps to reconstruct thumb web contractures.
The present work was carried out on 30 patients of both sexes in the age range of 1.5 years to 43 years (with a mean of 20.58 years) suffering from first web space contracture. The causes of the contracture in this study in descending order of frequency were postburn then posttraumatic then congenital.
Correction of the first web space contracture was carried out by using the technique of the dorsal rectangular and two volar triangular flaps. The degree of improvement was assessed by measuring the first web space span (which is an easy method estimated by measuring the distance between the lunula on the radial border of the index finger nail to the lunula on the ulnar border of the thumb finger nail with the thumb in the maximal abduction position). This was done before the operation and in the immediate and late postoperative period to assess the contracture present and to detect any recurrence.
All patients were assessed pre-operatively by history taking, systemic general examination, and local examination of the contracture and routine preoperative investigations. Digital photographs were taken before, during the operation and in the immediate and late postoperative period. The procedure was done under general anesthesia or regional anesthesia (local intravenous anesthesia).
The surgery was done under pneumatic tourniquet control. The dorsal rectangular flap was incised and the palmar rectangle was incised in a Z fashion to produce two triangular flaps based on the sides of the fingers. Release of the web was adequately done by releasing the contracted tissues which is a very crucial step during the treatment of first web contracture whatever the method of coverage to be used.
The tourniquet was deflated before insetting of the flaps to check the perfusion of the flaps and to achieve good haemostasis. Then mobilization and suturing of the flaps was done. Four patients required skin grafts in addition to the flap procedure, two of them were congenital, one posttraumatic and one postburn.
Follow up was done for a minimum of six months, to assess the results and detect and manage any complications. The complications included were either early complications as partial flap necrosis (3patients), hematoma (1patient), wound dehiscence (1patient), infection (1patient) or late complications as incomplete relief of web contracture (5 patients) and scar problems such as hypertrophic scar (which happened in 2 patients).
This study revealed that the technique of the dorsal rectangular and two volar triangular flaps deepened the web, and adequately covered both palmar and dorsal surfaces and that it is a simple and easy surgical technique which can be used in mild to moderate cases of first web contracture.