Pediatric Upper Extremity Symposium, Part 1 - CongenitalIndex Rotation Flap for Palmar Thumb Release in ArthrogryposisEzaki, Marybeth MD; Oishi, Scott N. MDAuthor Information Texas Scottish Rite Hospital for Children, Dallas, TX No outside funding was received for this work. Address correspondence and reprint requests to Marybeth Ezaki, MD, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. E-mail: Marybeth.Ezaki@tsrh.org. Techniques in Hand & Upper Extremity Surgery: March 2010 - Volume 14 - Issue 1 - p 38-40 doi: 10.1097/BTH.0b013e3181d44583 Buy Metrics Abstract 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. © 2010 Lippincott Williams & Wilkins, Inc.