Revision of the first web space: technics and results

Between 1975 and 1980, 91 patients in our series with involvement of 103 webs had revision of a contracted first web space. The five main causes of impairment were burns, trauma, congenital defects, cerebral palsy, and cerebrovascular accident. Technics used were simple Z-plasty; four-flap Z-plasty; modified double-opposing Z-plasty; and rotational flaps from the dorsum of the thumb, index finger, or hand. No pedicled, tubed, or distant flaps were needed. Simple Z-plasty was sufficient for increases to 1 cm; for greater increases a modified double-opposing Z-plasty or local rotational flap was necessary. The modified double-opposing Z gave excellent depth. Release of all contracting elements and addition of sufficient supple skin to the web are required for success.