Delayed skin graft application following burn scar release of the face and hand

Hypertrophic scars and contractures involving the face and hand secondary to burns were excised and the defects covered with saline compresses changed every 4 hours. Banked split-thickness skin grafts were applied 24 to 48 hours later. Upper and lower lip, cheek, forehead, scalp, neck, the first web space of the hand, and the flexor surfaces of the fingers were treated. Head and neck defects were grafted open. Hand defects created by release were maintained with dynamic splints and grafted open or covered with bolus dressings kept in place with sutures inserted at the time of creation of the defect. Jobst compression with elastomer inserts for added pressure was started postoperatively. It is believed that delay permitted natural hemostasis to occur without extensive electrocoagulation, which produces additional necrotic tissue. Anesthetic time was shortened. Delay also permitted capillary proliferation to start in the defect, hastening revascularization of the grafts.