title: Hyperpigmentation after surgery for a deep dermal burn of the dorsum of the hand: partial-thickness debridement followed by medium split-thickness skin grafting vs full-thickness debridement followed by thick split-thickness skin grafting.
abstract: BACKGROUND
  Early excision and skin grafting are commonly used to treat deep dermal burns (DDBs) of the dorsum of the hand. Partial-thickness debridement (PTD) is one of the most commonly used procedures for the excision of burned tissue of the dorsum of the hand. In contrast, full-thickness debridement (FTD) has also been reported. However, it is unclear whether PTD or FTD is better.
  
  
  METHODS
  In this hospital-based retrospective study, we compared the outcomes of PTD followed by a medium split-thickness skin graft (STSG) with FTD followed by a thick STSG to treat a DDB of the dorsum of the hand in Japanese patients. To evaluate postoperative pigmentation of the skin graft, quantitative analyses were performed using the red, green, and blue (RGB) and the hue, saturation, and brightness (HSB) color spaces. We have organized the manuscript in a manner compliant with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement.
  
  
  RESULTS
  Data from 11 patients were analyzed. Six hands (five patients) received grafts in the PTD group and eight hands (six patients) received grafts in the FTD group. Graft take was significantly better in the FTD group (median 98 %, interquartile range 95-99) than in the PTD group (median 90 %, interquartile range 85-90) (P < 0.01). Quantitative skin color analyses in both the RGB and HSB color spaces showed that postoperative grafted skin was significantly darker than the adjacent control area in the PTD group, but not in the FTD group.
  
  
  CONCLUSIONS
  There is a possibility that FTD followed by a thick STSG is an option that can reduce the risk of hyperpigmentation after surgery for DDB of the dorsum of the hand in Japanese patients. Further investigation is needed to clarify whether the FTD or the thick STSG or both are the factor for the control of hyperpigmentation.
authors: Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan.
authors: Yoshitaka
authors: Y
authors: Kubota
authors: Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan.
authors: Nobuyuki
authors: N
authors: Mitsukawa
authors: Department of Plastic Surgery, Tokyo Rosai Hospital, 4-13-21, Omoriminami, Ota-ku, Tokyo 143-0013 Japan.
authors: Kumiko
authors: K
authors: Chuma
authors: Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan.
authors: Shinsuke
authors: S
authors: Akita
authors: Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan.
authors: Yoshitaro
authors: Y
authors: Sasahara
authors: Department of Plastic Surgery, Chiba Rosai Hospital, 2-16, Tatsumidaihigashi, Ichihara, Chiba 290-0003 Japan.
authors: Naoaki
authors: N
authors: Rikihisa
authors: Department of Plastic Surgery, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, Chiba 260-8677 Japan.
authors: Kaneshige
authors: K
authors: Satoh
keywords: Hand burn; Hyperpigmentation; Skin graft