Selection of surgical methods for postburn scar contracture deformity in children′s hands
10.3760/cma.j.issn.1009-4598.2019.05.007
- VernacularTitle: 小儿手烧伤后瘢痕挛缩畸形的手术方式选择
- Author:
Huinan YIN
1
;
Jiake CHAI
;
Feng LI
;
Qi CHEN
;
Zhen YIN
;
Yingjie SUN
;
Xin CHEN
;
Hongmei YANG
Author Information
1. Burns and Plastic Surgery Department, Fourth Medical Center of PLA General Hospital, Beijing 100048, China
- Publication Type:Journal Article
- Keywords:
Child;
Hand;
Burned cicatricial contracture;
Skin grafting;
Surgical flap;
Lower abdominal flap
- From:
Chinese Journal of Plastic Surgery
2019;35(5):451-455
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the surgical methods for children with contracture deformity on hands after burn.
Methods:From January 2014 to January 2018, 33 pediatric patients, a total of 42 hands with scar contracture deformities were reviewed. There were 24 males and 9 females, aged from 11 months to 6 years and 7 months. Among them, 20 hands were volar metacarpophalangeal joint contractures, 9 were volar interphalangeal joint contractures, 7 were dorsal metacarpophalangeal joint contractures (3 claw-shaped hands), 3 were hand back contractures, and 3 were palm contractures. Of the 42 hands, 36 hands were repaired with full-thickness skin grafts or split-thickness skin grafts, after the removal of contracted scar, and 6 hands were repaired with abdominal skin flaps, due to the tendon or bone exposure after the scar removal.
Results:Skin grafts on 31 hands were all survived after 2 weeks. However, the survival area of 3 skin grafts was about 90%, and 2 skin grafts survived about 80%. All of them healed well after dressing changing. The 6 hands repaired with abdominal skin flap healed well too. After 1-2.5 years of follow-up, finger scar contracture occurred in 4 hands with skin grafting, and they were performed scar excision and sheet skin grafting. Three hands were treated with Z-plasty, due to web space contracture. The function of other hands were normal, without contracture or deformity. The skin color and texture were similar to the surrounding skin, with limited pigmented. Scars on the edge of skin grafts was not obvious. Patients and their families were satisfied.
Conclusions:The sheet skin graft is the main method for postburn scar contracture in children′s hands. The abdominal skin flap should be considered, if tendon or bone is exposed, especially for large wound or multiple sites.
