title: The Use of Glabrous Skins Grafts in the Treatment of Pediatric Palmar Hand Burns.
abstract: BACKGROUND
  An often overlooked, yet useful, technique in the treatment of palmar hand burns is the use of glabrous skin grafting, particularly in dark-skinned individuals. Pediatric palmar burns are a particularly unique subset of burns. The typical split-thickness or full-thickness skin grafts leave a notably different skin texture and pigmentation. It is also known that the psychological aspects of a pediatric burn can be quite burdensome for a child as he or she progresses through childhood and adolescence. For a dark-skinned patient the placement a standard full-thickness skin graft in a nonpigmented palm provides for a constant reminder of a traumatic event. We report a case series of pediatric patients who were managed with glabrous skin grafting from the plantar aspect of the foot.
  
  
  METHODS
  A retrospective review of palmar skin burns requiring grafting at a single pediatric burn center experience over a 2 and a half year time period was performed. Seventeen patients were identified. Our treatment algorithm for deep partial thickness burns first relies on a combination of operative and nonoperative measures to expedite the demarcation of the burn injury. If the burn is full thickness in nature or if a lack of progression of healing is identified within the first 14 days of injury, then skin grafting is recommended. Our technique for performing the graft is described.
  
  
  RESULTS
  The average age at time of surgery was 2.05 years (6 months to 6.8 years). Fourteen of the 17 patients had darker skin types (Fitzpatrick Type III-VI) and identified themselves as either Hispanic or African American. The average size of the area requiring skin graft after debridement was 0.94% total body surface area (0.5%-2.0%). Of the patients that were not lost to follow-up, 1 patient required additional grafting after developing a finger contracture for splint noncompliance. Aesthetically, the wounds went on to heal with an excellent pigment match and an inconspicuous donor site.
  
  
  CONCLUSIONS
  In the management of deep-partial or full-thickness palmar skin burns in the pediatric population that require grafting, the use of plantar glabrous skin grafts offers a reliable option for coverage. The aesthetic and functional results are improved over standard techniques.
authors.affiliation: From the *Division of Plastic Surgery, University of Mississippi Medical Center, Jackson, MS; †Division of Plastic Surgery, Indiana University, Indianapolis, IN; ‡Division of Plastic Surgery, Lehigh Valley Health Network, Allentown, PA; and §Division of Plastic Surgery, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Friel
authors.forename: Steve P
authors.initials: SP
authors.lastname: Duquette
authors.forename: Bharat
authors.initials: B
authors.lastname: Ranganath
authors.forename: Brooke A
authors.initials: BA
authors.lastname: Burkey
authors.forename: Paul M
authors.initials: PM
authors.lastname: Glat
authors.forename: Wellington J
authors.initials: WJ
authors.lastname: Davis
mesh_terms: D000465:Algorithms; D002056:Burns / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D005528:Foot / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012880:Skin Pigmentation; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome