First web space release with the dorsal hand rotation flap: closing the donor site

Release of first web space contractures with the dorsal hand rotation flap depends on the mobilization of relatively large areas of skin. Fortunately, the dorsum of the hand has sufficient laxity to accommodate such substantial flaps. Closure of the resultant donor site may be challenging. Skin grafting over extensor paratenon requires prolonged immobilization and is often cosmetically unsatisfactory. The purpose of this report is to demonstrate various methods of closing these donor sites without skin grafting. We report a series of first web space contractures, all of which we released using the dorsal hand rotation flap. In closing the donor sites, we demonstrate the utility of advancing local tissues as well as bilobed rotational flaps. Our series shows that skin grafting is not necessary in the majority of patients. We expect that our results will encourage the use of the dorsal hand rotation flap because it yields both functionally and cosmetically acceptable results.