Related Experiment Video
Updated: Dec 2, 2025
A Murine Model of a Burn Wound Reconstructed with an Allogeneic Skin Graft
Published on: August 8, 2020
Five Essential Principles for First Web Space Reconstruction in the Burned Hand
Mark A Greyson1, Suzanne C Wilkens1, Ravi F Sood1
1From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School; and the Division of Plastic Surgery, Shriners Hospital for Children-Boston.
Insights
First web space burn contractures in children are common. This study found split-thickness skin grafting followed by Z-plasty is preferred for optimal hand function reconstruction.
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.
Background:
Burn injuries commonly affect the hand, and the development of adduction contractures of the first web space is frequent and deleterious, both functionally and aesthetically. Many corrective techniques and algorithmic approaches have been described to treat this problem, but there is no consensus on the optimal management.
Methods:
A retrospective review at a single high-volume pediatric burn center was undertaken to evaluate the clinical course of these patients. All pediatric patients undergoing initial release of burn scar contracture of the first web space from 2005 through 2015 were included in a retrospective cohort study.
Results:
The authors identified 40 patients with 57 burned hands. The initial approach to management was variable. Z-plasty or other local flap was the first technique used in 28 hands (49 percent), split-thickness skin graft in 19 hands (33 percent), full-thickness skin graft in seven hands (12 percent), groin flaps in two hands (4 percent), and a reverse radial forearm flap in one hand (2 percent). The mean numbers of total reconstructive procedures per hand including the initial procedure were as follows: groin flap, 4.0; full-thickness skin graft, 3.1; split-thickness skin graft, 2.1; Z-plasty, 1.4; and reverse radial forearm flap, 1.0.
Conclusions:
Successful reconstruction of the first web space must be addressed in the context of the entire hand. It is the authors' preference to use split-thickness skin grafting whenever a skin deficiency is present-only then should leading edge contractures be addressed with Z-plasty. Based on their experience, the authors recommend five principles that are essential to successfully treat postburn contractures of the first web space.
Clinical Question/Level Of Evidence:
Therapeutic, III.
More Related Videos
08:01Virtual Hand with Ambiguous Movement between the Self and Other Origin: Sense of Ownership and 'Other-Produced' Agency
Published on: October 28, 2020
10:36Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
