Five Essential Principles for First Web Space Reconstruction in the Burned Hand.

Area of Science:

• Plastic Surgery
• Pediatric Burn Care
• Reconstructive Surgery

Background:

• First web space burn contractures significantly impair hand function and aesthetics.
• Optimal management strategies for these contractures remain debated.

Purpose of the Study:

• To evaluate the clinical course and outcomes of pediatric patients undergoing first web space burn scar contracture release.
• To identify key principles for successful reconstruction.

Main Methods:

• Retrospective cohort study of pediatric patients (2005-2015) at a high-volume burn center.
• Analysis of initial surgical techniques and total reconstructive procedures per hand.

Main Results:

• 40 patients with 57 burned hands were reviewed.
• Initial management varied: Z-plasty (49%), split-thickness skin graft (33%), full-thickness skin graft (12%), groin flaps (4%), reverse radial forearm flap (2%).
• Mean reconstructive procedures varied by technique, with groin flaps requiring the most (4.0).

Conclusions:

• Successful first web space reconstruction requires a holistic hand approach.
• Preference for split-thickness skin grafting for skin deficiency, followed by Z-plasty for contractures.
• Five essential principles are recommended for treating postburn first web space contractures.