Outcomes following soft tissue reconstruction for thermal hand burns

Background

Acute thermal burns can be severe injuries potentially requiring hospitalization and may even lead to limb amputation or permanent disability if not properly addressed. Primary burn reconstruction using flaps has been shown to be an effective method that optimizes tissue preservation, minimizes limb morbidity, and allows for early mobility. Previous studies have demonstrated the dependence of flap survival on several factors such as wound size, location, and specific tissue requirements (weight-bearing vs non-weight-bearing). Proper selection of soft tissue coverage for a wound defect is vital in ensuring adequate healing and recovery. Our objective was to identify whether the choice of flap leads to differences in near-term survival and postoperative complications in patients undergoing burn reconstruction for thermal hand injuries.

Methods

Retrospective review was performed of our single institution burn database to identify patients who underwent primary soft tissue reconstruction for thermal hand burns between September 2014 and March 2022. All patients had wound defects with significant depth not amendable to skin grafting alone for coverage. Medical records were reviewed for demographics, injury specifics, treatment details, and post-operative outcomes.

Results

Of all patients admitted to our institution over an 8-year period for burn-related injuries, we identified 17 patients requiring 28 local or regional flaps for reconstruction. All but one flap survived a minimum of two weeks post-operatively with a success rate of 96%. Complications included partial necrosis in 1 flap, full necrosis in the failed flap, dehiscence in 2 flaps, and hematoma in 1 flap. One patient developed a donor site hematoma requiring evacuation, and another developed flap cellulitis treated with IV antibiotics.

Conclusion

Local, regional, and distant flaps can reliably be used to salvage exposed tendons and neurovasculature in deep thermal hand burns. Flap success and subsequent outcomes rely heavily on the initial wound and extent of soft tissue injury, with flap type and timing acting as secondary predictors.