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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