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Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns
Yang Seo Park1, Jong Wook Lee, Gi Yeun Huh
1Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Insights
Primary full-thickness skin grafting (FTSG) is effective for pediatric hand burns, especially for isolated finger injuries without web space involvement. Guidelines are established based on long-term outcomes to minimize deformities and functional impairment.
Area of Science:
- Pediatric Surgery
- Burn Management
- Reconstructive Surgery
Background:
- Pediatric hand burns present unique challenges due to rapid growth and potential for severe deformities.
- Effective management from the acute stage is crucial to prevent long-term functional impairment.
- Establishing surgical guidelines for primary skin grafting is essential for optimal outcomes.
Purpose of the Study:
- To establish surgical guidelines for primary full-thickness skin grafting (FTSG) in pediatric hand burns.
- To evaluate the long-term outcomes of FTSG in pediatric patients.
- To provide evidence-based recommendations for managing pediatric hand burns.
Main Methods:
- Retrospective study of 210 pediatric patients undergoing primary FTSG from 2000 to 2011.
- Analysis of patient demographics, injury characteristics (site, web space involvement), and postoperative outcomes.
- Critical evaluation of the incidence of late deformities and duration of revision surgeries.
Main Results:
- The study included 210 patients with a mean age of 24.4 months, observed for an average of 6.9 years.
- Web space involvement was present in 33.3% of cases (70 patients).
- 25 cases (11.9%) required corrective operations, with an average delay of 40.6 months.
Conclusions:
- Primary FTSG is indicated for isolated volar finger injuries without web space involvement and injuries involving less than three fingers including web spaces.
- FTSG is also a good option for dorsal hand burns.
- Split-thickness skin grafting may be considered when donor sites are insufficient or wounds are extensive.
Background:
Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies.
Methods:
From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed.
Results:
The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months.
Conclusions:
In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.
