Functional and Cosmetic Outcome of Full- Versus Split-Thickness Skin Grafts in Pediatric Palmar Surface Burns

Abstract

Palmar hand burns continue to be a common injury in the pediatric population, with long-term implications for function, hand rehabilitation, and psychosocial well-being in a growing child. Debate over the choice of full-thickness skin grafts (FTSG) and split skin grafts (SSG) for optimal subsequent functional and cosmetic outcomes continues. This study prospectively evaluated children who required skin grafting of palmar burns at our institution between January 2008 and December 2009. A clinical assessment of the grafted area and donor site using the Vancouver Scar Scale, together with assessment of sensation, hair growth, and the development of contracture was performed by an independent clinician. Thirty-four (16%) of 214 palm burns that presented to our institution during this period required grafting, of which 26 (77%) agreed to participate in this study. At a mean 13.5 months postsurgery, pliability was significantly enhanced in FTSG compared with SSG (P < .001). Although not statistically significant, vascularity and height of SSGs were preferred. There was no difference in sensation between the two types of graft or donor site outcomes, although hair growth was significantly (P = .002) more prominent in FTSG. There were an equal number of contractures in the two groups, with grafts of either type that extended from the palm onto the volar aspect of digits more commonly affected. These data suggest an improved outcome in children with deep palm burns after FTSG, although with the exception of scar pliability these differences were small.

The use of split-thickness versus full-thickness skin graft to resurface volar aspect of pediatric burned hands: A systematic review

“…Manual screening of the references of those 8 articles was also conducted and 1 article [33] was found to be suitable for this review; however, the full text cannot be obtained. Finally, a total of 8 articles were included for review in this paper [5,11,[34][35][36][37][38][39] ( Table 1). The included studies consist of 1 prospective cohort study [11] and 7 retrospective cohort studies [5,[34][35][36][37][38][39].…”

“…Finally, a total of 8 articles were included for review in this paper [5,11,[34][35][36][37][38][39] ( Table 1). The included studies consist of 1 prospective cohort study [11] and 7 retrospective cohort studies [5,[34][35][36][37][38][39]. Six articles [5,11,34,[36][37][38] discussed early excision and skin grafting and 2 articles [35,39] addressed contracture release and skin grafting of pediatric palmar hand burns.…”

“…Controversy regarding which type of skin grafts is better to achieve good functional and esthetic outcomes in pediatric palmar hand burns is still present [11]. Based on our clinical experiences, the use of FTSG will still result in the formation of contracture due to poor compliance of long-term night splint use.…”

“…It is aggravated by the nature of the hand to flex in resting position (intrinsic minus posture) due to relatively greater strength of the flexor musculature [5,10]. This flexion contracture is undesirable since it will give long-term impacts toward children's hand function and psychosocial well-being [11].…”

Comparing Skin Grafts Harvested From Wrist With Those Harvested From Groin Region in Patients With Fingertip Injury: A Randomized Clinical Trial

“…Full-thickness skin graft has whole dermal and epidermal layer until 0.07 inch (0.178 cm) (1). Although hyperpigmentation and hair growth were found in most of the full-thickness skin grafts, full-thickness skin grafts have better sensory recovery (due to placement of sensory receptors at the deep dermis) and less contracture as well as breakdown in the fingertip skin; hence, it is the first choice when we have sufficient vascular bed at the receiver site (3,(10)(11)(12)(13)(14)(15)(16)(17). On the other hand, full-thickness grafts do not survive as readily as split thickness grafts and require a much better bed to be placed on.…”