474 Pediatric Hand Burns: Review of a Single Institution Experience

Abstract

Hand burns are common in the pediatric population. During the healing process development of scar contracture can be particularly morbid and severely limit sensation and mobility. The goal of our study was to retrospectively review our pediatric hand burn population with a specific focus on the length of time between injury date and intervention for scar contractures. With IRB approval a retrospective chart review of all patients less than 18 years old treated for hand burns between Jan 2013 and December 2016 was performed. Demographics, burn characteristics, treatments, hospital course, and follow up were recorded. Descriptive statistical analysis was performed; all medians reported with interquartile range. 140 patients were reviewed, the population was predominately male (86 patients, 59%), white (98 patients, 68%), with a median age of 2 years (IQR 1, 6.5). The most common type of burns was scalding 97 patients (67%), flame burns 36 patients (25%) and electrical burns 11 patients (7.6%). Second degree burns occurred in 128 patients (89%) with a median TBSA of 1.75 (IQR 1, 4). The most common location burned on the hand was the palmar aspect with 86 patients (60%), 35 patients (24%) were burned only on the dorsal aspect of their hand and 21 patients (15%) were burned on both the dorsal and palmar aspects. The median number of digits involved in the burn was 4 (IQR 2, 5). Ninety two patients (67%) had involvement of a joint. Median days of follow up was 16 (IQR 8, 40). 21 patients (15%) required operative intervention with a median age of injury of 2 years (IQR 1, 6.5). 6 (28%) of these patients required a second intervention. 5 patients (4%) developed clinically significant contractures after the wounds had completely healed. All five required subsequent opearative intervention, three patients underwent operative excision and grafting and two underwent adjacent tissue transfer flaps. The median days to intervention was 20 (IQR 16, 100). Clinically significant contractures make up a small percentage of pediatric hand burn outcomes. Aggressive physical therapy and more superficial burns may account for these findings. Review of the presentation and progression of pediatric hand burns will lead to new strategies to care for these common burns.