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The isolated burned palm in children: epidemiology and long-term sequelae
J P Barret1, M H Desai, D N Herndon
1Department of Surgery, Shriners Burns Hospital and the University of Texas Medical Branch, Galveston, USA. j.p.barret.nerin@chir.azg.nl
Insights
Pediatric palm burns are usually minor, but delayed healing increases scarring risk. Flame and contact burns are more likely to cause scarring and contractures in children.
Area of Science:
- Pediatric surgery
- Burn management
- Dermatology
Background:
- Isolated palm burns are common pediatric injuries.
- Management of small hands presents challenges.
- Long-term complications are frequent.
Purpose of the Study:
- To evaluate outcomes of pediatric palm burns.
- To identify risk factors for long-term sequelae.
Main Methods:
- Retrospective review of 120 pediatric patients with isolated palm burns (1988-1998).
- Analysis of burn depth, healing time, and treatment interventions.
- Assessment of sequelae, including contractures and need for reconstructive surgery.
Main Results:
- 110 partial-thickness, 10 full-thickness burns.
- Only 4 patients required excision and skin autografting.
- All surgically treated patients developed contractures.
- 13.3% developed palmar contractures, 56% requiring further surgery.
- Burns healing over 3 weeks had significantly more scarring (p<0.05).
- Flame and contact burns showed higher scarring incidence.
Conclusions:
- Pediatric palm burns generally have favorable outcomes with low late sequelae.
- Delayed healing (>3 weeks) is a significant risk factor for scarring.
- Flame and contact burns are associated with increased scarring.
- Surgical intervention in the acute phase does not prevent late sequelae.
Abstract:
The isolated burn of the palm is a typical injury in young children. Positioning and splinting in small hands is difficult, and long-term sequelae of these injuries are not uncommon. The objective of the present study was to assess the outcome of palm burns and to identify the risk factors for long-term sequelae. All patients admitted to our hospital affected with isolated palm injuries between January of 1988 and January of 1998 were reviewed. In total, 120 pediatric patients were admitted with isolated palm burns; 110 patients (91.7 percent) had partial-thickness burns, and 10 patients (8.3 percent) had full-thickness burns. Only four patients (3.3 percent) required excision and skin autografting, but all patients whose palms were operated on in the acute phase developed burn contractures. Sixteen patients (13.3 percent) developed palmar contractures, and more than half of them (56 percent) required reconstructive procedures. All palm burns that healed in more than 3 weeks developed scarring and sequelae (p<0.05 compared with no sequelae). Pediatric palmar burns are benign injuries with a low incidence of late sequelae. However, flame and contact burns are more prone to develop scarring. Excision and autografting should be performed on wounds that take over 3 weeks to heal, but it does not prevent late sequelae.