Index rotation flap for palmar thumb release in arthrogryposis.

The soft tissue envelope in congenital contractural conditions such as clasped or arthrogrypotic thumbs is often deficient in 2 planes, the thumb-index web and the flexor aspect of the thumb. Small local transposition flaps borrow tissue from 1 plane to augment the other and are likely to worsen 1 contracture whereas improving the other. Tissue must be added to the thumb envelope from outside the contracted areas. A flap based on the index finger can be designed to both open the thumb-index web and augment skin on flexor aspect of the thumb metacarpophalangeal joint. This flap is particularly useful in the congenital contractural conditions that have the appearance of a small ptyerigium or increased skin in the dorso-palmar plane of the index finger. After a comprehensive release of all the tight structures, this technique for skin closure is straightforward and the donor site can usually be closed primarily.