Snow and Littler technique of combined cleft closure and release of thumb adduction contracture (see text). A, Dorsal view. Skin incisions, flap elevation, and wound closure. B, Palmar view. Skin incisions, flap elevation, and wound closure. C, Index finger is transposed after osteotomy of base of index metacarpal and release of first dorsal interosseous muscle. D, Additional release of first dorsal interosseous subperiosteally from base of index allows transposition of index metacarpal to ring metacarpal base. Inset shows rotation necessary (possibly 45 degrees) for transposed digit to prevent overlap. E, Relationship of thumb adduction contracture release and palmar flap. Although release allows thumb mobility, area at C may not be covered by palmar flap and may require skin grafting. SEE TECHNIQUE 80.49.