Saeed Ashraf Cheema.
Reconstruction of first web space in consecutive 45 cases.
Surgimed Med Dent J Jan ;1(1):3-8.

OBJECTIVE: To demonstrate various modalities for reconstruction of first web space being utilized at the department. DESIGN. It was an clinical observational study. PLACE & DURATION. It was carried out at the Department of Plastic Surgery, Services Hospital Lahore from January 2004 to December 2006. PATIENTS & METHODS. A total of 45 patients were treated for reconstruction of first web space during last three years. These patients presented with a range of etiologies i.e., burns, mechanical trauma, fireworks injuries and road traffic accidents. Mechanical trauma (n = 11), fireworks blast injuries (n = 9) and post burn complications (n = 9) were the common etiologies. Reconstruction of the web space was carried out in these cases according to the principles of reconstructive ladder. Eight of cases needed release of contractures and deepening of the space with the help of various z plasties. In 32 cases various local, regional and distant flaps were utilized. Reverse radial artery flap ( n = 14) followed by dorsal metacarpal artery flap (n = 9) were the most common flaps utilized to cover the defects. Distraction osteogenesis was used in two cases. On top plasty was utilized in two other cases. RESULTS: Flap survived in all the cases except in one patient who experienced partial loss of flap. However, three cases presented with contractures due to lack of early follow up and poor compliance by the patients. CONCLUSION First web space is crucial for the normal hand function. Reconstruction of the web can be done with various methods. Choice of the method depends on the magnitude of the soft tissue defects and availability of the workable options.

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