STARplasty for reconstruction of the burned web space

Introduction of an alternative technique for the correction of dorsal neosyndactyly

C. Scott Hultman, Sumeet Teotia, Catherine Calvert, Sydney Thornton, Jennifer Schram

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Introduction: Significant hand burns frequently result in dorsal neosyndactyly, despite appropriate wound care, excision/grafting, and occupational therapy. Patients often develop limited abduction, tethered flexion/extension, intrinsic tightness, and inversion of the web space. We present a new technique for neosyndactyly release: the STARplasty (Syndactyly Treatment After Release), named after the appearance of the reconstructed web. Methods: We performed a retrospective review of 25 patients who underwent 66 web space reconstructions by a single surgeon, from January 2002 to December 2003. The STARplasty was developed prior to the study period, with the following goals: to use local tissue, negate the need for a skin graft, and permit early range of motion. Combined with longitudinal, transverse, and oblique releases, STARplasty uses a single volar flap, harvested from each sidewall of both proximal phalanges, with 30-degree corners. STARplasty simultaneously deepens and widens the web space while correcting the angle of inclination. Results: Sixteen patients (mean age: 34 years; range: 3-62 years) underwent a total of 33 STARplasties, an average of 37 months after burn injury. Mean area resurfaced per web was 5.2 cm2, which contrasts with the 33 non-STARplasty reconstructions, which were used to resurface a mean area of 19.4 cm2 (P < 0.05) and included 5-flap z-plasties (17), full-thickness skin graft (10), 2-flap z-plasties (3), and advancement flaps (3). No complications occurred in the STARplasty group, including infection, flap loss, dehiscence, nerve injury, or recurrent contracture. All patients had improved function (mean follow-up: 6.7 months; range: 1-18 months). Conclusions: STARplasty is a new, safe, and efficacious technique to correct dorsal neosyndactyly and reconstruct the web space after burn injury.

Original languageEnglish (US)
Pages (from-to)281-287
Number of pages7
JournalAnnals of Plastic Surgery
Volume54
Issue number3
DOIs
StatePublished - Mar 2005

Fingerprint

Wounds and Injuries
Syndactyly
Transplants
Skin
Occupational Therapy
Contracture
Articular Range of Motion
Burns
Hand
Infection
Therapeutics
Surgeons

Keywords

  • Burn injury
  • Starplasty
  • Syndactyly

ASJC Scopus subject areas

  • Surgery

Cite this

STARplasty for reconstruction of the burned web space : Introduction of an alternative technique for the correction of dorsal neosyndactyly. / Hultman, C. Scott; Teotia, Sumeet; Calvert, Catherine; Thornton, Sydney; Schram, Jennifer.

In: Annals of Plastic Surgery, Vol. 54, No. 3, 03.2005, p. 281-287.

Research output: Contribution to journalArticle

Hultman, C. Scott ; Teotia, Sumeet ; Calvert, Catherine ; Thornton, Sydney ; Schram, Jennifer. / STARplasty for reconstruction of the burned web space : Introduction of an alternative technique for the correction of dorsal neosyndactyly. In: Annals of Plastic Surgery. 2005 ; Vol. 54, No. 3. pp. 281-287.
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AB - Introduction: Significant hand burns frequently result in dorsal neosyndactyly, despite appropriate wound care, excision/grafting, and occupational therapy. Patients often develop limited abduction, tethered flexion/extension, intrinsic tightness, and inversion of the web space. We present a new technique for neosyndactyly release: the STARplasty (Syndactyly Treatment After Release), named after the appearance of the reconstructed web. Methods: We performed a retrospective review of 25 patients who underwent 66 web space reconstructions by a single surgeon, from January 2002 to December 2003. The STARplasty was developed prior to the study period, with the following goals: to use local tissue, negate the need for a skin graft, and permit early range of motion. Combined with longitudinal, transverse, and oblique releases, STARplasty uses a single volar flap, harvested from each sidewall of both proximal phalanges, with 30-degree corners. STARplasty simultaneously deepens and widens the web space while correcting the angle of inclination. Results: Sixteen patients (mean age: 34 years; range: 3-62 years) underwent a total of 33 STARplasties, an average of 37 months after burn injury. Mean area resurfaced per web was 5.2 cm2, which contrasts with the 33 non-STARplasty reconstructions, which were used to resurface a mean area of 19.4 cm2 (P < 0.05) and included 5-flap z-plasties (17), full-thickness skin graft (10), 2-flap z-plasties (3), and advancement flaps (3). No complications occurred in the STARplasty group, including infection, flap loss, dehiscence, nerve injury, or recurrent contracture. All patients had improved function (mean follow-up: 6.7 months; range: 1-18 months). Conclusions: STARplasty is a new, safe, and efficacious technique to correct dorsal neosyndactyly and reconstruct the web space after burn injury.

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