Factors that Affected Functional Outcome After a Delayed Excision and Split-Thickness Skin Graft on the Dorsal Side of Burned Hands.
Early excision and skin grafting is the principle treatment for a burned hand although there are occasions when it cannot be done such as severe general condition, delayed consultation, and the lack of a definitive assessment of burn depth. This study analyzes the factors that affected function after a delayed excision and skin graft for hands with a deep dermal burn. This study retrospectively evaluated 43 burned hands that required a delayed excision and split-thickness skin graft on the dorsal side. Cases were required to only have split-thickness skin grafting from the dorsum of the hand and fingers distally to at least the proximal interphalangeal joint at least 8 days after the injury. The hands were divided into two functional categories: Functional category A, normal or nearly normal joint movements, and functional category B, abnormal joint movements. Demographic data were assessed statistically by a univariate analysis following a multiple regression analysis by a stepwise selection. A significant difference was observed between the groups in the number of days from grafting to complete wound healing of the graft site and with or without an escharotomy in the analysis. These parameters were statistically significant predictors of functional category B. The functional outcome of a burned hand after a delayed excision and split-thickness skin graft on the dorsal side became degraded depending on the number of days from grafting to complete wound healing. Cases that underwent an escharotomy also showed deterioration in function.
From the *Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan; †Department of Plastic and Reconstructive Surgery, Sapporo City General Hospital, Japan; and ‡Department of Plastic and Reconstructive Surgery, Hakodate Central General Hospital, Japan.
Ryuji
R
Shichinohe
Yuhei
Y
Yamamoto
Kunihiro
K
Kawashima
Chu
C
Kimura
Kentaro
K
Ono
Katsumi
K
Horiuchi
Tetsunori
T
Yoshida
Naoki
N
Murao
Toshihiko
T
Hayashi
Emi
E
Funayama
Akihiko
A
Oyama
Hiroshi
H
Furukawa
D002056:Burns / Q000473:pathology / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*