A Clinical Analysis Of Hand Postburn Scar Contracture Deformity In Children

Objective To investigate the causes of pediatric hand burns scar contracture deformity and to analyze the postoperative effect and functional exercises of pediatric burn scar contracture in our institution,and also evaluating the effect of surgical treatment of hand scar.Methods Information on 121 children(129 number of injured hands)with hand burns scar contracture who underwent skin grafting operation was collected from 1st January 2013 to 31 st December 2016 in the First Affiliated Hospital of Guangxi Medical University.The causes of pediatric burns and the common types of deformity were analyzed.Surgical operation was performed according to the different burns scar contracture and the postoperative skin graft survival status was monitored.Follow up was performed in order to comprehend the appearance and functional recovery(about daily living)of hand after operation.Results(1)Epidemiology and the causes of child burn injury: The preschool children is main constituent part of burn injury in children,with 99 preschool children burn injuries,that accounted for 84.2% of the pediatric burn injury,of which 59 cases were those of early childhood,accounting for 51.75%of the total.The main cause of hand burns injury is hot liquid scald.With thegrowth and development of children,cases of burn wound which cause scar contracture declined since childhood.And although the proportion of flame burn injury increased,hot liquid scald still remains the main factor.(2)Gender and geographical distribution: hand scar contracture deformity is most common in boys,with 69(60.5%)cases male and 45(39.5%)cases of female,the ratio of boy:girl is 3:2.In the geographical distribution of pediatric hand scar contracture deformity,rural are prone areas and 90 cases of rural pediatric patients accounted for 78.9% of the total.(3)The condition of hand deformity after burn injuries: the types of hand deformity were mainly flexion deformity and back extension deformity.Flexion deformity accounted for 95.6% of the cases.And the left hand was more common,accounting for 55.7%.(4)surgery: A total of114 children underwent autologous skin grafting operation;among which the skin grafting survival condition was good in 96 cases,poor in 17 cases and bad in 1 case.In a number of 15 patients(13.16%)who were surgically treated within 3 months after injury,there were 4 cases of which the hand function was perfectly restored.In a number of 21 patients(18.42%)who underwent surgical treatment between 3 months to 6 months after injury,there were 12 cases of which the hand function was restored perfectly.In a number of 43 patients(37.72%)who were surgically treated in a treatment time between 6 months to12 months after injury,23 cases had their hand functions perfectly restored.And of the 35patients(30.70%)who underwent surgical treatment 12 months after injury,there were 10 cases with perfect hand function restored.(5)Follow-up: A total number 74 cases were followed up after operation and after hospital discharge,the follow up period was 3 months to 4 years.With rehabilitation exercise therapy after surgical treatment,the evaluation hand function restoration was: perfect in 49 patients,good in 22 patients and poor in 3 cases.The results show that there was a significantly improvement 95.95% in the hand function restoration of the patients.Conclusion(1)Pediatric burns are more common in infants,rural areas are more prone,and hot liquid scald is the main etiology of pediatric burns injury,while flame burns is the secondary cause.Thus,parents should pay more attention to children.(2)Flexion deformity is more common in pediatric hand scar contracture deformity,and treating pediatric hand scar contracture deformity by surgical operation between 6 months to 12 months after injury may have a good hand function restoration effect.If the burns scar contracture leads to serious deformity,surgical treatment should be performed as soon as possible.(3)Surgical treatment of hand scar contracture can restore hand function quickly,and the hand function evaluation of "good" can reach more than 90% in this study.