[Repair strategies and efficacy analysis of deep electrical burn wounds in children's fingers]

Objective: To explore the repair strategies for deep electrical burn wounds in children's fingers and analyze their efficacy. Methods: This study was a retrospective observational study. From January 2008 to January 2024, 80 children with deep electrical burn wounds in fingers meeting the inclusion criteria were admitted to Beijing Children's Hospital Affiliated to Capital Medical University, including 54 males and 26 females, aged 11 months to 12 years and 9 months with a total of 170 fingers affected. Repair strategies were formulated based on wound characteristics after debridement. For wounds with exposed tendons and/or bones, local flaps or abdominal pedicled flaps were preferentially used. For some of the patients who had higher aesthetic requirements for the donor sites, bilayer artificial dermis (AD)+split-thickness skin graft (STSG) was applied for wound repair. For wounds without exposed tendons or bones, full-thickness skin graft (FTSG) was used to repair those with full-thickness skin defects, while STSG alone was employed for wound repair in patients who had higher aesthetic requirements for the donor sites. Bilayer AD+STSG, abdominal pedicled flaps, or local flaps were used to repair the wounds with severe subcutaneous tissue defects located on the volar side of joints. For narrow strip-shaped wounds, direct suturing was performed regardless of tendon and/or bone exposure if tension-free closure was achievable, the incision direction was oblique or parallel to finger creases, and there was no risk of major vascular or nerve injury. The wounds were classified according to whether they were accompanied by tendon and/or bone exposure after debridement, the repair methods, wound area, and survival rate of flaps or skin grafts of the affected fingers were recorded. At the final follow-up, the total active motion (TAM) of affected finger joints was measured with a goniometer to assess function of affected fingers and the excellent and good ratio was calculated, the Vancouver scar scale (VSS) was used to evaluate scar conditions of affected fingers, and a self-designed scale was employed to survey the satisfaction of primary caregivers of the child with treatment outcomes. Results: Among the 59 affected fingers with wounds accompanied by tendon and/or bone exposure, 31, 9, 10, and 9 of them were treated respectively with abdominal pedicled flaps, local flaps, bilayer AD+STSG, and direct suturing, with the fingers that underwent direct suturing had the smallest wound area of 0.20 (0.20, 0.80) cm², and the fingers that were transplanted with abdominal pedicled flaps had the largest wound area of 2.00 (2.00, 4.00) cm². The median survival rate of flaps or skin grafts for the fingers transplanted with abdominal pedicled flaps, local flaps, and bilayer AD+STSG was 90%. The scar VSS score was the lowest 3.0 (2.0, 4.0) for fingers that underwent direct suturing, while the median scar VSS score was 4.0 to 5.0 for fingers that underwent other surgical procedures. The excellent and good ratio of joint TAM was the highest at 9/9 for fingers that underwent direct suturing, followed by 24/31 for fingers that underwent abdominal pedicled flap transplantation and 7/10 for fingers that underwent bilayer AD+STSG transplantation. The median satisfaction score of the primary caregivers of the child with the treatment outcomes was 9.0 points, except for those who underwent local flap transplantation, which was 8 points. Among the 111 affected fingers without tendon or bone exposure, 9, 5, 69, 11, 10, and 7 of them were treated respectively with abdominal pedicled flaps, local flaps, FTSG, STSG alone, bilayer AD+STSG transplantation, and direct suturing, with the fingers that underwent direct suturing had the smallest wound area of 0.25 (0.10, 0.50) cm², and the fingers that were transplanted with abdominal pedicled flaps had the largest wound area of 2.00 (1.50, 3.00) cm². The median survival rate of flaps or skin grafts for the fingers transplanted with abdominal pedicled flaps, local flaps, FTSG, and bilayer AD+STSG was 90%. The highest survival rate of skin grafts was 92% (90%, 100%) for fingers that underwent STSG alone transplantation. The scar VSS score was the lowest 3.0 (3.0, 4.0) for fingers that underwent direct suturing, while the scar VSS score was 5.0 (5.0, 7.0) for fingers that underwent bilayer AD+STSG transplantation, which was high. The excellent and good ratio of joint TAM was the highest at 5/5 for fingers that underwent local flap transplantation, while the excellent and good ratio of joint TAM was the lowest at 9/11 for fingers that underwent STSG alone transplantation. The median satisfaction score of the primary caregivers of the child with the treatment outcomes was 9.0 points, except for those who underwent abdominal pedicled flap or local flap transplantation, which was 8.0 points. Conclusions: For children's fingers with deep electrical burns, different methods can be used for wound repair according to specific circumstances with skin flaps as the preferred for repairing the wounds with exposed tendons and/or bones, skin grafts for repairing the wounds without tendon or bone exposure, and direct suturing for narrow strip-shaped wounds that meet the conditions to obtain the best functional and scar scores. Individualized repair plans can effectively balance the recovery of finger function and the satisfaction of caregivers with the therapeutic outcome.