1. Introduction

2. Surgical Approach

3. Release Contracture

a. Mark Donor Site

b. Inject Epinephrine

c. Harvest Graft

d. Trim Fat from Graft

e. Close Donor Site

4. Harvest Skin Graft

5. K-Wire Insertion

6. Skin Graft Inset

7. Local Block and Graft Site Dressing

8. Post-op Remarks

Trauma-related deaths cause many deaths per year, with burns contributing to many of these deaths. The morbidity and mortality of burns have shown a decline since the development of more scrupulous management. The complications stemming from a poorly-healed burn wound can lead to functional deficits and overall aesthetically unfavorable results leading to psychological distress. Due to the inquisitive nature of infants and toddlers, and their nature to learn the world with their hands, their sensitive regions like the hands become likely targets for burns. The rapid growth of infants places extra stress on the surgeon to recreate the normal anatomy of the flawed hand. Management differs depending on the size and depth of the burn wound. Superficial burns can be managed on an outpatient basis with spontaneous healing expected in 2 or 3 days with minimal scarring. Deep burns, particularly in pediatric populations, need considerable attention to avoid secondary contracture that leads to deformity. Many treatment options exist, but in sensitive areas like the hands and face, full-thickness skin grafts are favored due to their superior healing and decreased likelihood of secondary contracture. Advancements in modern medicine have expanded treatment options with nonoperative and operative procedures, along with the utilization of growth factors, such as TGF-B1 that accelerate healing. This article aims to guide the surgeon in managing a pediatric burn wound with an arsenal of treatment options with the goal of achieving full mobility and functionality of the hand.

Watch this full-length, narrated surgical video of a contracture release and full-thickness skin graft to volar index finger with K-wire insertion performed at Shriners Hospitals for Children in Boston

Shriners Hospitals for Children - Boston