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Full-thickness vs split-skin grafting in pediatric hand burns--a 10-year review of 174 cases

Manju D Chandrasegaram1, John Harvey

  • 1Children's Hospital at Westmead, Westmead NSW 2145, Australia.

Journal of Burn Care & Research : Official Publication of the American Burn Association
|August 21, 2009
PubMed

Insights

Full-thickness grafting (FTG) significantly reduces contractures in pediatric hand burns compared to split-skin grafting (SSG). FTG is particularly beneficial for palm and digit burns, minimizing the need for operative scar release.

Area of Science:

  • Pediatric Surgery
  • Burn Reconstruction
  • Hand Surgery

Background:

  • Contractures are a significant complication following pediatric hand burns.
  • Grafting techniques, including split-skin grafting (SSG) and full-thickness grafting (FTG), are used to treat these injuries.
  • The comparative effectiveness of SSG versus FTG in preventing contractures in pediatric hand burns requires further investigation.

Purpose of the Study:

  • To assess the incidence of contractures after grafting in pediatric hand burns.
  • To compare the outcomes of full-thickness grafting (FTG) versus split-skin grafting (SSG) in preventing post-burn contractures.
  • To evaluate the need for operative scar release based on the grafting method used.

Main Methods:

  • Retrospective review of 174 pediatric hand burns grafted between January 1997 and July 2007.
  • Patients were categorized into three groups based on graft location: hand grafts, digit grafts, and combined hand and digit grafts.
  • Incidence of contractures and operative release was analyzed comparing full-thickness grafting (FTG) with split-skin grafting (SSG).

Main Results:

  • Overall, contractures occurred in 27% of SSG cases versus 2% of FTG cases (P < 0.001).
  • Operative scar release was needed in 15% of SSG cases compared to 2% of FTG cases (P = 0.019).
  • FTG showed a significantly lower incidence of contractures, especially for grafts involving the palm and digits (0% vs. 43% for SSG in group C).

Conclusions:

  • Full-thickness grafting (FTG) is superior to split-skin grafting (SSG) in reducing contracture formation after pediatric hand burns.
  • FTG should be strongly considered for primary grafting of pediatric hand burns, particularly when the palm and digits are involved.
  • The use of FTG can decrease the likelihood of requiring subsequent operative scar release procedures.

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