Preventing web space contractures in hand burns

Dr Dinuksha De Silva1, Dr Aruna Wijewardena1

1Royal North Shore Hospital, Sydney, Australia

Abstract:

Hand burns are a common injury – they are involved in 42-80% of all burn injuries (van der Vlies et al. 2017, Kamolz et al. 2008), and can have a devastating impact on function and quality of life. A major contributor to this impact is web space scar contracture. It is the most frequent indication for reconstructive surgery after a hand burn (van der Vlies 2017), and a number of techniques have been described in the literature for web space contracture release. The mainstays for preventing this are supervised passive motion protocols and compressive garments (Fufa, Chuang & Yang 2014). However, can we optimise acute surgical management to help prevent web space contracture?

Here we present our experience at a tertiary burns centre in Sydney using a protocol initially described by Dr Chandini Perera (Burns and Plastic Surgeon, Sri Lanka). This technique involves grafting dorsal hand and finger burns without grafting the web spaces. We avoid grafting interdigital skin, as it contains a continuation of glabrous skin similar to that of the palm. A period of 21 days from injury is observed without operating on web space skin.

This surgical case series of hand burns outlines functional and cosmetic outcomes at follow up. Following the aforementioned protocol, we have been able to obviate the need for post-burn reconstructive surgery for web space contracture.

References
1. Fufa, DT, Chuang, SS & Yang JY 2014, ‘Postburn Contractures of the Hand’, Journal of Hand Surgery, vol. 39, no. 9, pp. 1869-1876.
2. Kamolz, LP, Kitzinger, HB, Karle, B & Manfred, F 2008, ‘The treatment of hand burns’, Burns, vol. 35, pp. 327-337.
3. van der Vlies, CH, de Waard, S, Hop, J, Nieuwenhuis, MK, Middelkoop, E, van Baar, ME, van Zuijlen & PPM 2017, ‘Indications and Predictors for Reconstructive Surgery After Hand Burns’, J Hand Surg Am, vol. 42, no. 5, pp. 351-358.


Biography:

Dinuksha is a surgical SRMO in the Burns and Plastics Department at Royal North Shore Hospital in Sydney.