113 Long-term Reconstructive Surgery of the Burned Hand: 16-year Experience at a Major Burn Center

Abstract

Abstract Introduction Early excision and grafting for deeper hand burns is important for preservation of long-term hand function. Little information exists on long-term reconstructive and revision operations after acute grafting. Limited quantitative data is available on early predictors of this outcome. This study retrospectively examines a cohort of patients who underwent excision and grafting of acute hand burns and details their reconstructive course in the years after injury. Predictors of future reconstructive hand surgery are examined. Methods A retrospective review was conducted using medical records of patients admitted with acute burn injury to a major regional burn center from February 1999 to October 2015 and who subsequently underwent excision and grafting for closure of the acute wound. Information collected included demographics, burn size and etiology, anatomical involvement, grafting, contracture release, local tissue rearrangement, and regional and distant flaps. Regression analysis assessed for demographic and clinical predictors for future contracture release with grafts and/or local tissue rearrangement surgery. Results A total of 704 hands in 532 adults (71% male, median age 40 years, average burn size 14.9% TBSA) met study criteria (Table 1). Ninety-eight patients underwent at least one reconstructive surgery (122 burned hands). Mean length of follow-up was 1000 days. Multivariable logistic regression analysis showed that male gender was negatively associated (p< 0.001; OR 0.369; 90% CI, 0.233–0.584) with contracture release with graft whereas white race (p=0.030; OR 2.060; 90% CI, 1.192–3.560) and burn size ≥21% TBSA (p< 0.001; OR 3.962; 90% CI, 2.224–7.057) were positively associated. Males had a negative association (p=0.023; OR 0.527; 90% CI, 0.332–0.837) and burn size a positive association with local tissue rearrangement (5–10% TBSA - p=0.041; OR 2.149; 90% CI, 1.161–3.975 and >21% TBSA - p< 0.001; OR 4.230; 90% CI, 7.927). Conclusions Approximately 1 in 6 acutely grafted hands underwent at least one reconstructive surgery of clinically significant contractures, primarily in digits and web spaces. Female gender and burn size were positive predictors of both categories of reconstructive surgery while white race was a positive predictor of release and graft.