Effectiveness of extensor carpi ulnaris tendon lengthening in treating four patients with tendinopathy

sion, the first web space was widened, and the flap then tunnelled subcutaneously to the created defect (Figure 2(B) and (C)). Following skin closure, vascularization of the flap was verified after releasing the tourniquet. Six months postoperatively, at the final follow-up, the patient showed a well-aligned and mobile thumb with a well-preserved first web space (Figure 3). First web deepening using Z-plasty or other skin mobilization techniques from the surrounding skin are the usual methods to treat an associated contracted first web space in radial polydactyly (Ogino et al., 1996; Townsend et al., 1994). A random rotation flap from the removed thumb or from the index finger has been also used (Ogino et al., 1996). The use of a neurovascular island flap from the removed thumb has been mentioned, although no technical details or images were provided (Ogino et al., 1996). The advantages of using a flap to widen the first web space include improvement of the web contour by keeping the height of the web and avoiding a ‘cleftlike’ appearance, which can be seen following conventional skin mobilization techniques (Fraulin and Thomson, 1999). In addition, 95% of duplicated thumbs present at least one palmar collateral artery, which should increase the utility of this surgical option (Kitayama and Tsukada, 1983). Coexistence of the first web contracture with radial polydactyly treated with a vascularized palmar flap obtained from the ablated thumb can result in potentially better cosmetic results as compared with deepening techniques.