First Palmar Intermetacarpal Flap for Congenital First Web Contracture: A Case Series

Background: Pediatric first web space contractures of the hand can lead to disability in hand function. Several techniques have been proposed for treating this condition. Recently, a new technique involving the first palmar cutaneous flap was described in a cadaveric study. This report aimed to elucidate the clinical outcomes of the first palmar intermetacarpal flap in patients with congenital first web space contractures.

Patients and methods: Case series of patients with moderate-to-severe first web contracture underwent surgery with the first palmar intermetacarpal flap. The variables included age, sex, diagnosis, preoperative and postoperative first intermetacarpal angle (IMCA), associated surgical procedures, postoperative complications, and follow-up time.

Results: Ten patients with a median age of 4 years and 8 months (range: 1 year and 5 months-16 years and 6 months) underwent surgery on a total of 12 hands. The median follow-up was 25 months (range: 12-49 months). IMCA increased in all patients following surgery, from a preoperative median of 20° (range: 0°-20°) to a postoperative median 40° (range: 30°-40°). Associated surgical procedures were performed in eight cases. Five simple complications occurred, including four cases of full-thickness skin graft pigmentation and one case of distal flap tip dehiscence.

Conclusions: The first palmar intermetacarpal flap is an effective option in the surgical management of moderate-to-severe first web contractures.