Correction of first web space deficiency in congenital deformities of the hand with the pseudokite flap

The authors describe a new nap to enlarge or create a first web in patients with congenital deficiencies of the hand. This lozenge-shaped flap is harv ested from the dorsoradial aspect of the index finger based on a narrow pro ximal skin bridge protecting its axial vascularization. A dorsal skin graft of the donor site is avoided by closure using a rhomboid flap. Procedures in 16 patients ri ere performed and reviewed; the only complication was ins ertion of a small split-thickness graft in five patients to avoid tension a t the metacarpophalangeal joint level. The flap lengthened the web fold an average of 3.2 cm without ''pseudolengthening" the thumb.