Five flaps or four? Z-plasty for the release of first webspace burn contractures of the hand

First webspace contractures are common indications for reconstructive burn surgery. Commonly performed procedures for this indication include either the four- or five-flap variations of the z-plasty, which involves the transposition of flaps about a central limb in order to obtain greater length, and thus, improve the thumb's important contribution to coordinated and precise hand function. This paper outlines the predominant reason for favouring the five-flap variation for this indication. This conclusion is derived from the notion that although the gain in length may be greater for the four flap, to make the comparison it assumes that the length of the central limbs are the same for the two techniques. For most cases, however, the central limb cannot exceed much >3 cm for a four-flap z-plasty, while 4 cm may be utilized for a 'jumping man' procedure.