00:00 this is Bobby Chopra and this is a video 00:02 showing our 4-flat z-plasty webspace 00:05 deepening procedure this is an 00:08 individual with AI PO plastic thumb who 00:10 had a first webspace contracture that 00:14 was limiting her ability to abduct and 00:16 her thumb and grasp objects we planned a 00:19 four five flap z-plasty in conjunction 00:23 with the EIP opponents plasti to help 00:26 improve her function a decision was made 00:30 in the first web space with symmetric 00:34 four flaps one at 90 degrees along the 00:39 dorsal and bowler aspect of the of the 00:42 crease and then an additional one at 45 00:45 degrees in a reciprocal fashion as shown 00:50 here this is a standard for flap 00:52 z-plasty and we made sure that each of 00:56 the limbs were of equal a size to ensure 01:01 adequate deepening of the first webspace 01:06 incision was made carefully care was 01:08 taken to prevent to prevent manipulating 01:16 the tips of the incision as this can 01:19 lead to tip necrosis but careful 01:23 dissection was performed full thickness 01:26 with care to prevent injury to any 01:28 underlying nerve structures these flaps 01:32 were elevated and until adequate they 01:40 were released adequately so that they 01:42 can be transposed careful dissection is 01:48 performed and as you can see the flaps 01:52 are very carefully handled blood 01:55 dissection was performed to ensure that 01:58 all flaps were released and then by AB 02:01 ducting the thumb the flaps should fall 02:04 into their appropriate places if the 02:10 incision is planned a pro 02:13 appropriately with equal size limbs 02:15 corner stitches are used to inset each 02:18 of the flaps as shown here and in this 02:26 manner and excellent deepening is 02:28 obtained of the first web space this is 02:31 a very functional procedure if if done 02:39 appropriately and does take adequate it 02:43 does take optimal preoperative planning 02:45 so that appropriate an appropriate flap 02:49 is created once the procedures completed 02:52 dressing is applied