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Release of the first web space with the "goalpost" procedure in pediatric burns
T A Housinger1, B Ivers, G D Warden
1Department of Surgery, University of Cincinnati College of Medicine, Shriners Burns Institute, OH 45229.
Insights
The goalpost procedure effectively treats first web-space contractures in pediatric burn patients, improving thumb motion without complications or repeat surgeries. This method enhances both abduction and extension for burn survivors.
Area of Science:
- Plastic Surgery
- Pediatric Burn Reconstruction
- Hand Surgery
Background:
- First web-space contractures are common after hand burns, limiting thumb abduction and extension.
- These deformities significantly impact hand function and quality of life in pediatric patients.
- Minimizing reoperation is crucial for growing children with burn-related contractures.
Purpose of the Study:
- To describe and evaluate the "goalpost" procedure for treating first web-space contractures in pediatric burn patients.
- To assess the efficacy and safety of this technique in improving thumb motion.
- To determine the need for repeat operations in the follow-up period.
Main Methods:
- A retrospective review of 31 first web-space releases using the goalpost procedure in 23 pediatric patients (mean age 9.2 years) between 1987 and 1989.
- Operations were performed a mean of 50 months post-burn injury.
- Outcomes assessed included wound complications, need for reoperation, and changes in thumb range of motion (abduction and extension).
Main Results:
- No wound complications were reported in any of the 31 procedures.
- None of the patients required a repeat operation during the follow-up period.
- A mean increase of 10 degrees in both thumb abduction and extension range of motion was observed.
Conclusions:
- The goalpost procedure is a safe and effective technique for correcting first web-space contractures in pediatric burn patients.
- This method successfully addresses both abduction and extension deformities, offering advantages over standard releases.
- The procedure demonstrates a low complication rate and eliminates the need for reoperation in growing children, making it a highly acceptable treatment option.
Abstract:
First web-space contractures commonly occur in dorsal and palmar hand burns. Both abduction and extension limitations develop as a result of reduction in thumb motion. Optimal treatment of first web-space contractures should treat both abduction and extension deformities and should minimize the need for reoperation in growing children. Many techniques exist to manage web-space contractures. This article describes a long rectangular flap release ("goalpost" procedure) used to treat first web deformities in pediatric patients with burns. During the period 1987 through 1989, 31 first web-space releases were performed in 23 patients (mean age 9.2 years). The operations were performed a mean of 50 months after burn injury. No wound complications occurred and no patient required repeat operation in the follow-up period. Range of motion in abduction and extension was increased a mean of 10 degrees. The goalpost procedure is a highly acceptable alternative to standard web-space releases and offers advantages in its ability to treat both abduction and extension contractures.