Evaluation of Functional Outcomes After Reconstruction of Post-burn Contracture of the Hand in the Pediatric Age
Shobhana Rajasekar1, Karthikeyan Gomathinayagam2, Sriman Narayan Madan Mohan3
1Department of Hand Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND.
Insights
Flap procedures offer better functional outcomes for pediatric hand burn contractures compared to Z-plasty and skin grafts. This surgical approach aids in restoring daily living activities and hand function post-injury.
Area of Science:
- Reconstructive surgery
- Pediatric hand surgery
- Burn management
Background:
- Hand burn injuries significantly impair activities of daily living (ADL).
- Severe burns can lead to contractures, requiring complex surgical reconstruction and prolonged rehabilitation, particularly in children.
- Psychological support is crucial for managing residual deformities and improving cosmetic outcomes.
Purpose of the Study:
- To evaluate functional outcomes of different surgical reconstructive procedures for post-burn hand contractures.
- To determine the optimal surgical intervention for restoring hand function essential for ADL in pediatric patients.
Main Methods:
- A prospective interventional study involving 40 pediatric patients with post-burn hand contractures.
- Surgical interventions included flap procedures, Z-plasty, and skin grafts.
- Functional outcomes were assessed using the Modified Jebson Hand Function Test (JHFT) after a minimum of four months.
Main Results:
- Patients undergoing flap procedures demonstrated average functional outcomes.
- The Modified JHFT revealed that fine motor, weighted, and non-weighted hand functions were improved with flap procedures.
- Z-plasty and skin graft procedures resulted in poor functional outcomes for the majority of pediatric patients.
Conclusions:
- Managing pediatric hand burn contractures is complex, necessitating timely intervention and appropriate surgical techniques.
- Flap procedures are superior to Z-plasty and skin grafts for improving hand function and ADL in children with post-burn contractures.
- The choice of reconstructive procedure significantly impacts postoperative results and functional recovery.
Abstract:
Background Injuries on the hand due to burns affect the quality and functions of activities of daily living (ADL). Severe burns cause lasting complications and deformities, such as contracture of the hand, which require multiple staged surgeries and rehabilitation for extended periods to regain function. This is of major significance to children, as they are in the growing and developmental age group, which should be considered while planning a reconstructive procedure. Psychological counselling is equally important for these patients to accept the residual deformity and cosmesis of the hand following surgery. Methods A prospective interventional study was conducted on 40 patients to assess the functional outcomes of various reconstructive procedures for post-burn contracture of the hand and to find out which is the better surgical intervention for restoring the hand functions needed for ADL. Functional outcomes were analyzed using the Modified Jebson Hand Function Test (JHFT) after a minimum of four months. Results In the group of children operated on with flap procedures, the maximum number of patients had average functional outcomes. Functional outcomes were assessed using the Modified JHFT, in which fine motor, weighted, and non-weighted hand function activities were assessed and analyzed. However, in the group of children operated on by the Z-plasty procedure and skin graft procedure, the maximum number of patients had poor functional outcomes. Conclusion The management of burn injuries on the hand and subsequent contractures is often challenging, especially in pediatric patients. Timely intervention, patient education, and surgical skills with an appropriate choice of reconstructive procedures play a vital role in achieving good postoperative results. This study showed that hands reconstructed using flap procedures had good functional outcomes compared to graft and Z-plasty procedures.
