Burned Hand Reconstruction

Burned Hand Reconstruction

David A. Billmire

Kim A. Bjorklund


  • Pediatric skin is thinner and has not yet developed the thickened palmar epidermis of an adult.3

  • Dorsal skin is thin and pliable and provides less protection for underlying extensor tendons and bone.


  • Thin dorsal skin places underlying structures at particular risk for exposure and stiffness.

  • Extensor tendons are particularly at risk at the PIP joints where the central slip may attenuate or rupture with exposure, resulting in a boutonniere deformity.

  • Burned hands tend to assume a position of wrist flexion, MCP hyperextension, PIP flexion, thumb adduction, and interphalangeal hyperextension.4

  • Early elevation, splinting, and escharotomies when indicated affect postburn edema and help prevent the development of burn contractures.

  • Altered sensation and motor and nerve function may occur secondary to the burn.


  • Untreated or inadequately treated hand burns frequently result in contractures and long-term functional impairment.

  • Early involvement of a multidisciplinary team with aggressive elevation, splinting, hand therapy, and early excision and grafting for deep burns is essential.

  • Hand burns that are unlikely to heal within 2 weeks of injury should undergo tangential excision and skin grafting.5

  • Palmar burns are more likely than dorsal burns to heal spontaneously from glabrous skin appendages and may be less likely to require grafting.

  • Approximately 78% of pediatric palm burns heal without the need for grafting; however, flexion contractures of the fingers and/or shortening of the thenar-hypothenar distance may occur when burns take greater than 2 to 3 weeks to heal.6,7

  • Secondary burn deformities may occur as a child grows because burn scars do not grow at the same rate as the rest of the child’s hand and may impede overall bone and soft tissue growth.3

  • Secondary burn deformities include intrinsic minus deformities (“claw hand”); palmar cupping deformity; web space deformities; hypertrophic scars and/or scar bands; finger deformities including boutonniere, swan neck and mallet deformities; and deformities of the nail.8


  • Evaluation of the location, size, depth, and previous treatment of the burn

  • Mechanism of injury (thermal, contact, chemical, electrical)

  • Previous splinting and hand therapy

  • Nature of the contracture (extension, flexion)

  • Skin and soft tissue adequacy and contracture

  • Tendon function—flexor and extensor

  • Assessment of sensation and vascular status of the hand and digits

  • Joint contractures—passive and active range of motion

  • Bony deformities and inadequate growth

  • Assessment of the entire upper extremity

    • Wrist or elbow contractures may need to be addressed to adequately position the hand in space.


  • Plain radiographs of the hands and digits should be assessed for bony deformities, joint contractures, or destruction.


Feb 27, 2020 | Posted by in Pediatric plastic surgery | Comments Off on Burned Hand Reconstruction

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