Plast Reconstr Surg Glob Open 2026 Jun 29;146:e7895. doi: 10.1097/GOX.0000000000007895.

The Starfish Procedure for Functional Recovery after Traumatic Partial Hand Amputation: A Case Report and Review of the Literature.

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BACKGROUND: Partial hand amputations present significant reconstructive challenges because traditional reconstructive techniques and prosthetic devices often provide limited restoration of functional pinch and grip. The Starfish procedure is a novel reconstructive technique designed to optimize residual limb function and facilitate advanced prosthetic integration following complex partial hand amputation. METHODS: A 30-year-old man sustained a traumatic partial hand amputation involving digits 2-5. Following initial wound stabilization and staged revision amputation, reconstruction was performed using regenerative peripheral nerve interfaces, full-thickness skin grafting, and the Starfish procedure. The intrinsic hand muscles were repositioned subcutaneously while preserving their neurovascular supply to create independent soft-tissue units suitable for myoelectric prosthetic control. RESULTS: The patient achieved successful wound healing without postoperative complications. At 1-year follow-up, he demonstrated functional recovery, including intuitive and independent digit control with a myoelectric prosthesis, return to light-duty work, and the ability to perform activities of daily living. Restoration of tripod pinch and improved functional hand use appeared to exceed outcomes typically achieved with conventional reconstructive or prosthetic approaches. CONCLUSIONS: The Starfish procedure represents a promising reconstructive option for select patients with complex partial hand amputations. By combining innovative surgical reconstruction, targeted prosthetic integration, and multidisciplinary rehabilitation, this technique may improve functional outcomes and expand the reconstructive armamentarium available for severe hand injuries.

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