Prise en charge des séquelles de brûlure palmaire chez l’enfant, à propos de 49 cas

Abstract

Even if they represent only 2.5% of the total body surface area, the hands are burnt in 50% of hospitalized patients. The risk of sequelae is significant, especially in children, human being in full growth, and a source of aesthetic and functional handicap. The aim of this study is to research the predictive factors of sequelae, to study their treatment of and their evolution. We included children under six years of age with deep palmar burns of the hand between 1998and 2008. Demographics, characteristics of the initial burn and its treatment were noted. Then, we studied the types of hand burn sequelae and their treatment. Finally, we observed their evolution over time with an aesthetic and functional evaluation and their impact on quality of life. Forty-nine children, representing 70hands, were included in the study. The mean age at the time of the initial burn was 16.2months (6; 60). The initial treatment was directed healing in 39% of cases and thin skin excision-grafting in 61% of cases. The type of sequelae most represented was bridle in 73% of cases. Treatment consisted of rehabilitation measures (13%) or surgery (69%). The mean age at the time of surgery was 10.1years (4; 19). These were plasties (62%), total skin grafts (15%) or a combination of both (23%). The current follow-up is 16.2years. The aesthetic result is considered good in 52% of cases, the functional result is good in 78% of cases. The impact on the quality of life is low and the parents are satisfied with the initial care. The treatment of the sequelae of burnt hands gives good results but involves well-conducted rehabilitation and regular monitoring. The treatment period must be adapted and the surgery simple, effective and specific to the type of sequelae.