Background: Soft tissue reconstruction of the first web space remained a challenge for plastic and reconstructive surgeons. First web space adduction contractures are a common consequence of hand burns. Many reconstructive techniques are used and investigation for more effective methods continues. Objective: assess the range of movement as regard opposition, palmar abduction and thumb extension. Also assessed the depth of web space after reconstruction of post burn contracted first web space to ass the method of covering the defect after release.. Materials and Methods: 35 patients' ages ranged from 12 to 59 years (with mean 31.7), years; 23 males and 12 females admitted to our Hospital during the period from June 2008 to May 2012. All patients were suffering from post-burn first web contractures. The patients underwent a variety of surgical procedures. The follow-up period ranged from one to three years. Results: Full range of motion achieved in most patients, but not those with joint affections. Conclusions: In our experience, surgical correction of first web space contractures-in the form of flaps good results followed by skin grafts-results in meaningful functional enhancement. The outcomes depend primarily on the severity of contracture. Functionally limiting recontracture is rare in our experience and its best prevented by appropriate therapy

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Introduction:Children have a high chance of suffering burn injury regardless of their physiological, psychological, and developmental differences. Burn injuries have short term and long term impacts on children and families. Paediatric burns of the upper extremity have devastating multidimensional consequences especially the capacity and perceived self-efficiency for functioning.It is the pediatric nurses' role to advocate for and ensure proper management of burn related consequences on the child and family. Aim of the present study isto evaluate the effect of Implementing exercise training program on joint functioning and perceived self-efficacy of children with upper extremity burn.Design:A quasi-experimental research design was used in the present study. Subjects: convenience sampling of 43 male and female pediatric survivors with deep 2 nd and 3 rd degree upper extremity burn was carried out at pediatricburn ward at emergency hospital of main Tanta University Hospital.And outpatient clinic of El Mansoura hospital for Dermatology, Venereology & leprosy at El dakahlia governorate.Four tools were used for data collection: Structure questionnaire sheet of children withupper extremity burn, Quick Disabilities of the Arm, Shoulder and Hand Scale (Quick DASH), joints function assessment, andSelf-Efficacy Questionnaire for Children (SEQ-C).Results:Thirty-six burned children had 3rd degree, with mean age 13.38±1.73 were assigned for this study. Significant cumulative improvement of the upper extremities range of motion and functional ability was observed after application of exercise rehabilitation program, in addition to significant upgrading of academic, emotional and social efficacy. Conclusion:The study concluded that the children's range of motion of burned upper extremities improved after the implementation of the exercise training program. The burned children showed an improvement of their perceived selfefficacy after implementation of the training program.Recommendations: Promoting awareness among pediatric nurses, pediatricians and physiotherapists about the necessity of integrating an exercise program into care plan for burned children is critical. Standardizing parameters, standards and guidelines that allow for adequate tracking of progress in this burn survivors population is also substantial.

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