Reconstruction of the pediatric burned hand.

It is clear that reconstruction of pediatric hand burns is a complicated task (Fig. 8), and attention to details during the acute phase of injury may be surgeons' greatest ally in subsequent functional rehabilitation of the hand. Reducing edema, maintaining digital circulation, limiting inflammation, and mobilizing the limb early are key parameters to assure return of function during the acute phase of injury. Although children may present with neglected contractures at a later date, even grade IV contractures can be surgically approached with hopes of improving hand function. Loss of the thumb in children with very large total body surface area burns can be approached reliably by lengthening of the thumb using first-to-second metacarpal transfers, as described by Littler. Although electrical injuries represent only a small fraction of patients admitted to our hospitals, children who present with viable insensate hands can have reliable sensory return more than 1 year after injury using nonvascularized cable nerve grafts if soft tissue coverage is adequate. As surgical procedures continue to evolve in delayed reconstruction of the hand, one would expect children to show better results than those seen in adult patients. A more aggressive surgical approach, with increased optimism, therefore is required when addressing children with complex hand burns requiring reconstruction.