Presentation and Management Outcome of Post-burn Contractures of the hands and Wrists in Children

Abstract

Objectives: To document the epidemiologic profile of children with post burn contractures (PBCs) of the hands and determine the relative contribution and success rate of various reconstructive tools employed in their management.

Methodology: This descriptive case series study was carried out at the National Institute of Rehabilitation Medicine, Islamabad over a period of five years. All children who presented with PBCs of the hands or wrists of at least one-year duration were included. Children who had associated contractures elsewhere in the body were excluded. The primary outcome measure was the adequacy of contracture release and survival of the flaps and grafts whereas the secondary outcome measure was the recurrence of contracture at one-year follow-up.

Results: Out of 177 children, 81.35% (n=114) were males and 18.64% (n=63) were females. The age ranged between 1-14 years with a mean age of 4.51±3.79 years. Fingers and thumbs 80(45.19%) were the commonest site of PBCs. This was followed by contractures of the first web space 23(12.99%); wrist contractures 21(11.86%); claw hand deformities (n=17: 9.60%); fist hand deformities (n=15: 8.47%); dorsal hand contractures 11(6.21%); and post burn syndactyly 10(5.64%). The various reconstructive procedures performed included full thickness skin grafts (FTSGs) (n=91); Z-plasties (n=73); groin flaps (n=40); split thickness skin grafts (STSGs) (n=7); and abdominal and posterior interosseous flaps (n=3) each. 44 (95.65%) flaps healed without any complications. 

Conclusion: Postburn contractures of the hands were more frequent among male children aged 1-5 years. Scalds were the commonest underlying cause of these contractures. Z-plasties and full thickness skin grafts were the most commonly employed reconstructive tools. Majority of the children had successful contracture release and survival of the flaps and grafts employed for the reconstruction. Recurrence at one year was observed among 12.99% children.