The first web space of the hand plays a fundamental role in daily hand function, facilitating crucial movements, such as pinching, grasping, and opposition. The structural anomalies of acquired defects of this anatomical region, whether secondary to trauma, burns, or post-oncological surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced microsurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limitations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplantation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques.

The first web space of the hand plays a fundamental role in daily hand function, facili-tating crucial movements such as pinching, grasping, and opposition. Structural anom-alies and acquired defects of this anatomical region, whether congenital or secondary to trauma, burns, or surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced mi-crosurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limi-tations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplan-tation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques.