TechniqueThe Starfish Procedure for Independent Digital Control of a Myoelectric ProsthesisDenduluri, Sahitya K. MD; Rees, Andrew MD; Nord, Keith M. MD; Loeffler, Bryan J. MD; Gaston, R. Glenn MD Author Information OrthoCarolina Hand Center and Atrium Musculoskeletal Institute, Charlotte, North Carolina, USA Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding. Address correspondence and reprint requests to R. Glenn Gaston, MD, OrthoCarolina Hand & Upper Extremity Center, 1915 Randolph Road, Charlotte, NC 28207. E-mail: [email protected]. Techniques in Hand & Upper Extremity Surgery ():10.1097/BTH.0000000000000412, October 3, 2022. | DOI: 10.1097/BTH.0000000000000412 Buy SDC PAP Metrics Abstract Management of partial hand amputations is a notable clinical challenge. Historically, myoelectric prostheses have not allowed for independent digital control, resulting in unsatisfactory function and high rejection rates among upper extremity amputees. The Starfish Procedure was developed for patients who sustained loss of multiple digits through the level of the base of the proximal phalanx or distal metacarpal. The procedure involves the pedicled transfer of 1 or more dorsal interosseous muscles to a subcutaneous location. This allows for a myoelectric sensor to capture the signals generated by these transferred muscles, thereby enabling intuitive, independent, digital prosthetic flexion and extension. In this article, we detail the relevant anatomy, indications, and technique for performing the Starfish Procedure. Given our patients’ promising outcomes to date, we hope this technique paper will encourage upper extremity surgeons of all training backgrounds to perform this relatively straightforward procedure, thereby allowing patients with life-altering finger amputations to regain meaningful function by enhancing control of digital prostheses. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.