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.

Pediatric partial-thickness burns at function-critical sites require rapid epithelialization to limit hypertrophic scarring and contracture. We assessed outcomes after tangential dermabrasion with application of cryopreserved human amnion (hAM). Retrospective single-center cohort of children < 18 years treated from 2013 to June 2024. Standard care included early tangential dermabrasion and hAM fixation. Primary endpoint was days from injury to ≥ 95% re-epithelialization. Secondary endpoints included length of stay, autografting, hAM-related adverse events, hypertrophic scarring, contracture, and Patient and Observer Scar Assessment Scale (POSAS) at 12 months. Ninety-seven children were included (median age 1.8 years; 60.8% male; median total body surface area burned 10%). Median time to first dermabrasion and hAM application was 24 h. Median time to ≥ 95% re-epithelialization was 16 days. Larger burns healed more slowly (+1.22 days per 1% total body surface area; p < 0.001). Median length of stay was 8 days; autografting occurred in 19.6%. No adverse events were attributed to hAM. Hypertrophic scarring occurred in 34% and contracture in 13.4%. Longer time to closure increased the odds of hypertrophic scar (odds ratio per 5 days 1.20; p = 0.040) and contracture (odds ratio per 5 days 1.28; p = 0.002). After standardized dermabrasion, cryopreserved hAM supported closure within the expected healing window. Time to epithelialization remained the main determinant of scar outcomes.

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.

Incisional negative pressure wound therapy has expanded from a niche adjunct to a widely adopted strategy for the prevention and management of wound complications in selected surgical settings. However, available systems differ in pressure profile, fluid handling, dressing interface, and suitability for fragile skin or anatomically challenging incisions, while practical guidance for device selection remains limited. Whether iNPWT should be used selectively is an established question; which system characteristics are relevant once its use has been judged appropriate is not. We conducted a structured narrative review of the literature on incisional negative pressure wound therapy published between January 2013 and September 2026, based on a targeted PubMed/MEDLINE search. Clinical studies addressing primarily closed surgical incisions were reviewed across elective, emergency, and reconstructive settings; conventional negative pressure wound therapy for open wounds was considered only in order to define the boundary between the two indications. Device technical characteristics were extracted separately from manufacturers' instructions for use and clinician guidelines. Evidence was synthesised in relation to clinical indication, incision and patient characteristics, device features, reported outcomes, and treatment‐related adverse events. On this basis, a clinical‐requirement‐first decision framework for bedside device selection was developed, with each component labelled as direct clinical evidence, indirect clinical evidence, documented technical characteristic, or expert clinical consideration. The available evidence supports a selective rather than routine use of incisional negative pressure wound therapy. The greatest clinical value appears in high‐risk incisions and in settings where oedema, superficial fluid accumulation, or limited soft‐tissue protection are likely to contribute to wound morbidity. Reported benefits vary according to procedure type, baseline risk, endpoint definition, and device configuration. Published studies evaluate complete proprietary systems rather than isolated technical variables. The only randomised comparison between two commercial systems identified was small and found no difference between them. Adverse events remain relevant and may limit treatment in fragile skin or when drainage exceeds the fluid‐handling capacity declared for the selected dressing. Incisional negative pressure wound therapy should be considered an adjunct to standard preventive measures, not a universal solution. A structured approach integrating anticipated fluid‐handling requirements, perilesional skin tolerance, seal feasibility over the relevant anatomy, and intended therapy duration may support more rational and transparent device selection once iNPWT has been judged appropriate. Current evidence does not establish a hierarchy among commercially available incisional systems, and the framework should be regarded as structured decision support rather than as a validated algorithm.

Replantation of an amputated finger is a complex microsurgical procedure that is rarely attempted in low-resource settings due to limited infrastructure and expertise. We report a case of complete amputation of a finger in rural Kenya that was successfully replanted during a humanitarian surgical mission. A 28-year-old man sustained a severe crush avulsion agricultural machine injury resulting in the amputation of all ten digits; only one digit was deemed suitable for replantation. The replantation was performed under loupe and microscope magnification by a visiting specialist team in collaboration with local staff. Intraoperatively, bony fixation with Kirschner wires, extensor and flexor digitorum profundus tendon repair, arterial and venous anastomoses, and neurorrhaphy of the digital nerve were achieved. Postoperatively, the finger survived with adequate perfusion. At one-month follow-up, the replanted finger was viable with progressing wound healing and early joint motion; further rehabilitation was arranged to maximize functional recovery. This case, which is, to our knowledge, one of the first documented digital replantations in East Africa, illustrates that successful microsurgical limb salvage is feasible in a non-specialized hospital setting. Our experience underscores that, with proper planning, training, and teamwork, advanced reconstructive procedures like finger replantation can be safely carried out even in resource-constrained hospitals, offering patients in low-income regions outcomes previously achievable only in high-resource centers.