Eighteen forearm flaps were used in 12 patients with congenital anomalies following release of severe first web-space contractures. Radial forearm axial pattern flaps were preferred in 10 children, and the dorsal interosseous system was used in 2 patients with incomplete palmar arches and those who had previous surgery. Ten of the flaps were transferred in children younger than 2 years of age. The results were excellent both esthetically and functionally. Superficial skin loss occurred in one patient. These local vascular island flaps are an excellent alternative for coverage in situations where a large tissue deficiency exists after an adequate release.