gms | German Medical Science

Objectives/Interrogation: Finger burns are often seen in children, and some patients with deep hand burns are treated with split-thickness or full-thickness skin grafts. The typical split-thickness or full-thickness skin grafts leave a notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating the digital flexion contracture with full-thickness plantar skin grafting, and to evaluate the appearance and function outcomes.

Methods: The hematoxylin and eosin (HE) staining, Masson trichrome staining and Melan A immunohistochemical staining was tested for palmar skin, plantar skin, groin skin and burn scar. Full-thickness plantar skin grafting was performed between 2008 and 2015 for 18 fingers in 12 hand burn patients with digital flexion contracture. The average age at time of surgery was 14 months and the average time of follow-up was 5.6 years. The subjective evaluation was given by patients' parents on both the functional and cosmetic results. Scar appearances were assessed using a Vancouver Scar Scale (VSS). The modified Tada scoring system was used for objective evaluation.

Results and Conclusions: The plantar skin shared similar attribute with the palmar skin histologically. Both the plantar skin and the palmar skin did not express the Melan A. The color of the grafts became similar to adjacent tissues. The average active range of motion (ROM) for the fingers was improved from 32° to 86° in MCP, from 23° to 84° in PIP, from 42° to 77° in DIP. 10 good (83.3%), 2 fair (16.7%) and no poor was obtained based on the modified Tada scoring system. There was no hypertrophic scar on the plantar donor site. The patients' parents were satisfied with the function and appearance in 11 patients (91.7%). Average VSS score was improved from 9.62 to 2.16.

The full-thickness plantar skin grafting could achieve a satisfactory appearance and good function for hand burn patients with digital flexion contracture.