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Published on: February 23, 2024
[How to treat palmar burn sequelae in children, about 49 cases]
C Barani1, S Brosset2, H Person2
1Service de chirurgie plastique, reconstructrice et esthétique, hôpital Saint-Joseph Saint-Luc, 20, quai Claude-Bernard, 69007 Lyon, France.
Insights
Treating deep palmar hand burns in children yields good aesthetic and functional outcomes with appropriate rehabilitation and surgery. Long-term follow-up shows low impact on quality of life, with satisfied parents.
Area of Science:
- Pediatric Burn Surgery
- Hand Reconstructive Surgery
- Sequelae Management
Background:
- Hand burns, despite covering only 2.5% of body surface area, occur in 50% of hospitalized patients.
- Children are at high risk for significant aesthetic and functional sequelae from hand burns due to ongoing growth.
- Identifying predictive factors for burn sequelae and their long-term outcomes is crucial.
Purpose of the Study:
- To identify predictive factors for sequelae in pediatric hand burns.
- To analyze the treatment and evolution of hand burn sequelae in children.
- To evaluate the long-term aesthetic and functional results and impact on quality of life.
Main Methods:
- Study included children under six with deep palmar hand burns (1998-2008).
- Data collected on demographics, burn characteristics, initial treatment, sequelae type, and treatment.
- Long-term follow-up assessed aesthetic, functional outcomes, and quality of life.
Main Results:
- Forty-nine children (70 hands) were analyzed; mean age at burn was 16.2 months.
- Bridle formation was the most common sequela (73%), treated with rehabilitation (13%) or surgery (69%).
- Good aesthetic results (52%) and functional results (78%) were achieved, with low impact on quality of life.
Conclusions:
- Treatment of pediatric hand burn sequelae can yield good results with proper rehabilitation and monitoring.
- Treatment duration and surgical approaches should be tailored to sequelae type for optimal outcomes.
- Effective management requires adapted treatment periods and simple, effective, specific surgical techniques.
Introduction:
Even if they represent only 2.5 % of the total body surface area, the hands are burnt in 50 % of hospitalized patients. The risk of sequelae is significant, especially in children, human being in full growth, and a source of aesthetic and functional handicap. The aim of this study is to research the predictive factors of sequelae, to study their treatment of and their evolution.
Material And Methods:
We included children under six years of age with deep palmar burns of the hand between 1998 and 2008. Demographics, characteristics of the initial burn and its treatment were noted. Then, we studied the types of hand burn sequelae and their treatment. Finally, we observed their evolution over time with an aesthetic and functional evaluation and their impact on quality of life.
Results:
Forty-nine children, representing 70 hands, were included in the study. The mean age at the time of the initial burn was 16.2 months (6; 60). The initial treatment was directed healing in 39 % of cases and thin skin excision-grafting in 61 % of cases. The type of sequelae most represented was bridle in 73 % of cases. Treatment consisted of rehabilitation measures (13 %) or surgery (69 %). The mean age at the time of surgery was 10.1 years (4; 19). These were plasties (62 %), total skin grafts (15 %) or a combination of both (23 %). The current follow-up is 16.2 years. The aesthetic result is considered good in 52 % of cases, the functional result is good in 78 % of cases. The impact on the quality of life is low and the parents are satisfied with the initial care.
Conclusion:
The treatment of the sequelae of burnt hands gives good results but involves well-conducted rehabilitation and regular monitoring. The treatment period must be adapted and the surgery simple, effective and specific to the type of sequelae.
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