Effectiveness of web space pressure inserts for postburn dorsal slant

Postburn web space scar, if not appropriately treated, can result in the progressive loss of the web space or the increase in angle of the dorsal slant of the web space or both, which will not only lead to cosmetic and hygiene problems, but also to functional limitations. The purpose of this study was to determine the effectiveness of web space pressure inserts for postburn dorsal slants. An individualized custom-made web space pressure insert was fitted into each web space. Inserts were worn underneath the pressure glove to create additional pressure on each web space and to inhibit distal migration of the scar to avoid the increase in the angle of the dorsal slant of the web space. Twenty-four survivors with 36 burned hands, who had been treated in the burn clinic of National Cheng Kung University Hospital, were recruited for this study. When skin wounds were closed, the participants received custom-made web space pressure inserts. The dorsal slant of each web space was measured by a conventional goniometer every time the participants visited the burn clinic. The initial and final measurements were used to compare the change in the angle of the dorsal slant of the web space. Paired t-tests were computed to determine the effectiveness of pressure inserts. The final dorsal slant angle of each web space was also compared with the unburned value by independent t-test. After 234.6 +/- 177.0 days of intervention, the mean dorsal slants of 36 dorsal burn hands' four web spaces were all significantly reduced (P < .001). The most important finding was that the angle of the first dorsal slant could be improved to normal. A custom-made web space pressure insert could be used to improve postburn dorsal slant.