Management of burn contractures of the first web space of the hand

First web space contractures of the hand affect predominantly the movements at the trapeziometacarpal joint, rendering the thumb ineffective for opposition and thereby destroying the essential elements of grasp and pinch. Adequate release of contractured first web space followed by a local skin flap cover and dynamic abduction splintage for the subsequent 6 weeks gives excellent results. Documenting the first web angle at every follow-up visit can detect early recurrences and the dynamic splintage can be reinstituted to achieve the normal first web space. Secondary surgery in the form of flexor pollicis longus tendon lengthening or opponens-plasty helps to prevent recurrences.