STARplasty for reconstruction of the burned web space: introduction of an alternative technique for the correction of dorsal neosyndactyly.

Abstract

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. 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. 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 cm, which contrasts with the 33 non-STARplasty reconstructions, which were used to resurface a mean area of 19.4 cm (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). STARplasty is a new, safe, and efficacious technique to correct dorsal neosyndactyly and reconstruct the web space after burn injury.