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Obtaining the Requisite Signals to Allow Independent Digital Control of a Myoelectric Prosthesis with the Starfish Procedure
Casey M. Sabbag, MD1; R. Glenn Gaston, MD1; Bryan J. Loeffler, MD2
1OrthoCarolina, Charlotte, NC; 2Hand Center, OrthoCarolina Hand Center, Charlotte, NC

Introduction:
The hypothesis of this study was that the Starfish procedure can provide viable signals to enable independent digital control of a myoelectric prosthesis.
Materials & Methods:
This was a retrospective review of prospectively collected data approved by our institutional Review Board. An internal database query was performed based on the CPT codes for Starfish procedure for all patients with partial hand amputation from 20172019. Patients were included if they had been compliant with their routine follow-up. At these routine follow up visits, patients completed a standardized research outcome packet (including DASH, VAS scores, Satisfaction scores and Common Functional Activity Ratings) and underwent clinical of the upper extremity that included activation of transferred muscles, evaluation of wound healing, and functional use of prosthesis. Demographic and clinical data from hospital and clinic medical records were recorded. Standard descriptive statistics are reported including measures of central tendency, variance as well as frequencies and proportions.
Results:
There were 15 patients included in this series. Of these, 2 were female (13%) and 13 were male (87%), the mean age was 43 years old (range 22 66), 9 were Caucasian and 6 were other race/ethnicity, mean follow-up was 2.1 (range 1.2 2.9) years. All patients had recordable signals with myoelectric testing and/or were actively using a myoelectric prosthesis. Patients reported an average wear rate of 5.5 hours per day and mean of 5.5 days per week. Average common functional activity ratings (1-8 with 1 being the most common) were grooming 5.5, dressing 2, eating 3, meal preparation 3, housework 2.5, yardwork 3, recreation 4, work 5. DASH scores pre-surgery and post-surgery were obtained with average pre-surgery DASH score of 52.1, post-surgery without prosthesis 58.3, and post-surgery with prosthesis of 40.4 (p=0.31). Patient reported VAS pain scores (0 10) post-operatively for residual pain were mean of 3.5 (07.5) and for phantom pain was 2.2 (06.3). Commonly reported challenging tasks included dressing, pinching, yardwork, bathing and tying shoes.
Conclusions:
This is the first report of outcomes in patients undergoing Starfish procedure for partial hand amputations and acquiring and using a myoelectric prosthesis with independent digital control and all patients had viable myoelectric signals present at most recent follow-up. Patients undergoing this procedure report daily prosthetic use with improvements in DASH scores post-operatively. Although the procedure resulted in functional improvements, some residual pain and difficulty with certain daily tasks was observed.


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