الفهرس 
Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Soft tissue reconstruction of the first web space remained a challenge for plastic and reconstructive surgeons. Skin defects of the first web space created after the release of post-burn contractures could be covered by skin graft, fascial Pedicled flaps, distant flaps, or free flaps, depending on the patient’s general condition and the conditions of the local wound and donor site.
First web space contracture is a debilitating condition that can severely impair patients’ hand function. The resulting restricted thumb movement can dramatically affect one’s ability to oppose their digits and have devastating impacts on both vocational and a vocational pursuits. These contractures have many etiologies including congenital, traumatic, and post-surgical. They can be treated by several modalities including skin grafts, z-plasties, local–regional flaps, free tissue transfer, intrinsic muscle releases, and trapeziectomy.
The Disability of the Arm, Shoulder, and Hand (DASH) outcome measure is an instrument that allows physicians to assess physical function and symptoms in patients with upper extremity disorders. It has been repeatedly validated as a tool to measure hand and arm function in patients with disabilities and is the gold standard for upper extremity outcome measures.
The presence of an adequate first web space is essential for thumb and prehensile hand function. The web contracture may be the result of damage to the skin, muscles, tendons, nerves, or bones of the first 2 rays, generally as a consequence of trauma, burn, infection, and neoplasia. If there is a severe adduction of the thumb it is necessary to perform a wide release of all contracted deep first web structures, which results in a skin
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defect on both sides of the hand. In this situation a local flap is inadequate1 and it is necessary to perform distant flap, island flap, or a free-tissue transfer.
With the recent development of perforator flaps some investigators have described the application of the anterolateral thigh flap for reconstruction of the hand and upper extremity. In these studies the anterolateral thigh flap often was used in its entire thickness, leaving bulkiness that was unsuitable for particular areas of the hand such as the first web space.
The aim of the study was to study different options to first web space reconstruction.
This was a clinical trial study was conducted, including 30 patients with first web deformities: group (A): included 10 patients managed by five flaps. group (B): included 3 patients managed by posterior interosseous flap. group (C): included 3 patients managed by first dorsal metacarpal flap. group (D): included 5 patients managed by Z-plasty, group (E): included 4 patients managed by STSG.
The main results of the study revealed that:
Regarding age, the mean age was comparable among the studied groups with no statistical significance found between the groups.
Regarding sex and laterality, there was no significant difference found between the groups.
Regarding cause, burn injury was the most prevalent cause.
There no significant difference between the studied groups regarding flap size and preoperative first web space angle
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There no significant difference between the studied groups regarding postoperative thumb opposition and abduction and first web space angle.
However, there a significant increase in thumb opposition and abduction and first web space angle postoperatively.
Based on our findings, we recommend for further studies on large geographical scale and on larger sample size to emphasize our conclusion.