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American Association for Hand Surgery

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Management of Pediatric Hand Burns and Indications for Reconstructive Surgery: A Single Center Review
Kathryn S King, MD1, Grace Wei, BS1, Austin Van Vliet, BS1, Kimberly Maynell, MSN, ARNP, FNP-C, RNFA2 and David J Smith, MD1, (1)University of South Florida, Tampa, FL, (2)Tampa General Hospital, Tampa, FL

Purpose: The primary objective of the study was to analyze the prevalence of surgical intervention for acute hand burns in the pediatric population as well as the need for future reconstructive surgery.

Methods: A retrospective review of all pediatric patients treated with superficial partial thickness, and above, hand burns at a single burn center from October 1, 2011 through June 30, 2019. The details of acute burn treatment and need for operative intervention, in both the acute and chronic settings, were examined.

Results: A total of 664 pediatric patients with hand burns were examined, fifty-four (8%) required operative intervention to their hand burns. Fifty-two percent of patients underwent excision with skin grafting, of those 28% ultimately required additional surgery for a chronic problem (hypertrophic scarring and/or scar contracture). In comparison, 26 patients (48%) were treated with dressing changes alone or operative debridement without grafting. Of those patients treated without acute grafting, 42% ultimately required additional surgery for a chronic problem. Nineteen patients (3% of all pediatric hand burns) in total required intervention for chronic problems related to flexion contractures or hypertrophic scaring.

Conclusions: Pediatric hand burns often heal well without resultant chronic complications though when such complications occur, they can be debilitating and require long-term care as the child grows. In our series of pediatric hand burn patients, 8% of patients required any operative intervention at all with 3% requiring intervention on a chronic problem. We have found that CO2 laser therapy plays an important role in treatment of hypertrophic scars and serves as a great adjunct to treatment of flexion contractures. Additionally, we recommend conscientiousness in regards to the location of skin graft seams in acute grafting, particular caution should be taken with webspace's. While chronic complications in pediatric hand burns may be uncommon they are important to recognize and treat to allow for adequate hand function. These patients require long-term follow-up as they can develop repeat contracture as they grow.

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