1. Introduction

2. Release Scar Contracture

a. Mark Patient

b. Inject Local Anesthetic and Calibrate Electric Dermatome

c. Prepare Skin

d. Perform Harvest

3. Skin Graft Harvest

4. Hemostasis

5. Skin Graft Inset

6. Graft Dressing and Wrap

a. Context

b. Dermabrasion

c. Harvest Skin Graft

d. Place Skin Graft

7. Permanent Pigment Transfer

8. Dress Wounds and Inject Additional Local Anesthetic

9. Discussion of Splint

10. Fractional CO2 Laser Resurfacing

11. Post-Op Remarks

Pediatric burns are one of the most common forms of injury affecting children worldwide. Of these, hand involvement occurs in 80–90% of such incidents. With the skin in children already diffusely thinner throughout the body than that in adults, this provides a particular challenge for areas that naturally possess thinner skin, such as the dorsal hand. The cutaneous tissue there is the only protection for vital structures in the hand that allow full function, such as extensor tendons, nerves, and vessels. Injury to this area early in life can have a detrimental impact on how the survivor interacts with the physical world, affecting their functional capacity and quality of life. Today we present a case of burn contractures on the right hand of an 8-year-old boy that will be released using a split-thickness graft, along with a pigment transfer graft for his left knee and fractional CO2 laser therapy over areas of hypertrophic scar tissue on his bilateral upper extremities. The split-thickness graft will greatly decrease the tension built up from the burn contracture, while the fractional CO2 laser procedure can soften the surrounding scar, allowing mild remodeling and increased range of motion.

Watch full-length surgical video article performed and narrated by Dr. Daniel Driscoll. A split-thickness skin graft, permanent pigment transfer, and fractional CO2 laser therapy are performed on an 8-year-old male with burn scars.

Shriners Hospitals for Children - Boston