Thumb web reconstruction

Contracture of the thumb-index web space negates the ability of the thumb to diverge from the remainder of the hand and consequently to converge toward the fingers in grasp. This is a review of the anatomy of the tetrahedral space and defines the secondary factors leading to web space restriction, including factors related to the mechanism of injury. Treatment is determined by the severity of the condition. The impairment is classified as mild, moderate, or severe, depending on the magnitude of the tissue damage. Specific treatment for joint contractures, bone defects, muscle fibrosis, and inappropriate skin coverage is presented by a format of functional anatomy and surgical technology. Prevention of web space contracture is the key to success.