J Korean Soc Plast Reconstr Surg.  2009 Mar;36(2):147-152.

Anterolateral Thigh Flap for 1st Web Contracture Release

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Kwangmyung Sung-Ae General Hospital, Kyungki-do, Korea. ophand@yahoo.com

Abstract

PURPOSE
First web space contracture of the hand has been treated with various surgical techniques such as Z-plasty, local flap, pedicled flap, distant free flap, and anterolateral thigh free flap. Among those surgical techniques, anterolateral thigh free flap provide a thin and pliable flap, which is a useful method for correction of first web space contracture.
METHODS
From August 2003 to September 2007, the authors selected 9 patients who had first web space contracture with limitation of thumb abduction within 30 degrees. All of patients had received first web contracture release with anterolateral thigh free flap. Age ranged from 24 to 51, and all the patients were male. Average follow up period was 12 months and the authors performed photographic analysis of the thumb abduction angle of postoperative increase.
RESULTS
All the flaps were survived. Donor site was closed with primary closure in 8 cases and covered with split-thickness skin graft in 1 case. Average flap size was 8x9cm and average thickness was 0.6cm in suprafascial flap. The procedure resulted in increased thumb abduction angle of 34.7degrees in average and showed concave shape of first web space in suprafascial flap. Additional operations were performed with Z-plasty in 3 cases, local flap in 5 cases, and opponensplasty in 3 cases.
CONCLUSION
In suprafascial flap, we obtained relatively thin flap thickness and were able to make natural concave shape of first web space. In releasing severe contracture of the first web space, anterolateral thigh free flap provided a good coverage of appropriate thickness and pliable soft tissue and allowed limited donor site morbidity.

Keyword

First web space contracture; Anterolateral thigh flap

MeSH Terms

Contracture
Follow-Up Studies
Free Tissue Flaps
Hand
Humans
Male
Skin
Surgical Flaps
Thigh
Thumb
Tissue Donors
Transplants
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