Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns

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.