The cross incision plasty for reconstruction of the burned web space: introduction of an alternative technique for the correction of dorsal and volar neosyndactyly.

Significant hand burns frequently result in dorsal and/or palmar 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 Cross Incision Plasty." We performed a retrospective review of 15 patients who underwent 35 web space reconstructions by a single surgeon from January 2004 to February 2007. The cross incision plasty was developed before 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 and transverse releases, the cross incision plasty uses the four finger flaps, harvested from each sidewall of both proximal phalanges with 90-degree angle. The cross incision plasty simultaneously deepens and widens the web space while correcting the angle of inclination. Fifteen patients (mean age: 13.3 years; range: 3-24 years) underwent 35 cross incision plasties after burn injury. No complications such as infection, flap loss, dehiscence, nerve injury, or recurrent contracture were seen in the cross incision plasty group. All patients improved function (mean follow-up: 15.2 months; range: 9-22 months). The cross incision plasty is a new, safe, and efficacious technique to correct dorsal and palmar neosyndactyly and reconstruct the web space after burn injury.