Plastic surgery; its principles and practice . of the fingers of the left hand. Male, aged 20years.—Note the difference in the extension as compared with the other hand. Inthis case there was great shortening of the skin and underlying tissues. The first phalan-geal joint surfaces were also distorted from long continued flexion. When more than twofingers are involved it is advisable to operate on only one, or possibly on two fingers, atone time. The second stage shows confirmed contracture with hyperextensionof the first phalanx. The second and third phalanges are flexed in thesame line, more
Plastic surgery; its principles and practice . of the fingers of the left hand. Male, aged 20years.—Note the difference in the extension as compared with the other hand. Inthis case there was great shortening of the skin and underlying tissues. The first phalan-geal joint surfaces were also distorted from long continued flexion. When more than twofingers are involved it is advisable to operate on only one, or possibly on two fingers, atone time. The second stage shows confirmed contracture with hyperextensionof the first phalanx. The second and third phalanges are flexed in thesame line, more or less rigidly upon the first. The finger cannot be MALFORMATIONS 247 straightened even with moderate force. There is no evidence of mus-cular contracture, but in most cases some contracted bands of fasciamay be detected. The skin also seems to be contracted, and thearticular ligaments are shortened by the long continued flexion. Laterprogressive contracture of the little finger is likely to occur, and otherfingers may also be Fig. 204. Fig. 205. Figs. 204 and 205.—Bilateral congenital contracture of the little fingers in twins.—I and I. Note amount of extension in both little fingers. 2 and 2. Photographs taken after operation. The contracted skin bands were divided by Z-shaped the ligaments of the first interphalangeal joints were divided as far from the joint aspossible, and the skin was closed after straightening the fingers. Perfect functionfollowed. The contracture, which is probably primarily due to thickening ofthe central strip of the digital fascia, is aggravated by the shrinkage ofthe skin, and the gradual shortening of muscles and articular the old cases even the shape of the joint may become changed and inextreme cases amputation of the little finger may be necessary. 248 PLASTIC SURGERY —Adams advises the multiple subcutaneous divisionof all the fascia bands, and after the finger has been stra
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