Operative First Web Contracture Management: Current Strategies.

» First web contractures can be due to nonthermal trauma, burns, congenital differences, and Dupuytren contracture.» Mild cases are managed with contracture release and full-thickness skin graft or when surrounding skin is pliable, Z-plasty.» Release of severe contractures creates a tetrahedral void that may require local or distant flap coverage. Reconstructive options include dorsal transposition flaps, regional rotation flaps, free tissue transfer, first metacarpal distraction osteogenesis with web deepening, or pollicization.