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Arch Plast Surg. Sep 2012; 39(5): 483–488.
Published online Sep 12, 2012. doi:  10.5999/aps.2012.39.5.483
PMCID: PMC3474405
Algorithm for Primary Full-thickness Skin Grafting in Pediatric Hand Burns
Yang Seo Park, Jong Wook Lee,corresponding author Gi Yeun Huh, Jang Hyu Koh, Dong Kook Seo, Jai Koo Choi, and Young Chul Jang
Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
corresponding authorCorresponding author.
Correspondence: Jong Wook Lee. Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 12 Beodeunaru-ro 7-gil, Yeongdeungpo-gu, Seoul 150-719, Korea. Tel: +82-2-2639-5704, Fax: +82-2-2676-2431, jwlpsdoc/at/yahoo.co.kr
Received May 8, 2012; Revised July 4, 2012; Accepted July 20, 2012.
Abstract
Background
Pediatric hand burns are a difficult problem because they lead to serious hand deformities with functional impairment due to rapid growth during childhood. Therefore, adequate management is required beginning in the acute stage. Our study aims to establish surgical guidelines for a primary full-thickness skin graft (FTSG) in pediatric hand burns, based on long-term observation periods and existing studies.
Methods
From January 2000 to May 2011, 210 patients underwent primary FTSG. We retrospectively studied the clinical course and treatment outcomes based on the patients' medical records. The patients' demographics, age, sex, injury site of the fingers, presence of web space involvement, the incidence of postoperative late deformities, and the duration of revision were critically analyzed.
Results
The mean age of the patients was 24.4 months (range, 8 to 94 months), consisting of 141 males and 69 females. The overall observation period was 6.9 years (range, 1 to 11 years) on average. At the time of the burn, 56 cases were to a single finger, 73 to two fingers, 45 to three fingers, and 22 to more than three. Among these cases, 70 were burns that included a web space (33.3%). During the observation, 25 cases underwent corrective operations with an average period of 40.6 months.
Conclusions
In the volar area, primary full-thickness skin grafting can be a good indication for an isolated injured finger, excluding the web spaces, and injuries of less than three fingers including the web spaces. Also, in the dorsal area, full-thickness skin grafting can be a good indication. However, if the donor site is insufficient and the wound is large, split-thickness skin grafting can be considered.
Keywords: Burns, Child, preschool, Skin transplantation
Articles from Archives of Plastic Surgery are provided here courtesy of
Korean Society of Plastic and Reconstructive Surgeons