Deep palmar thermal burns in children: predictive factors of post‑burn contracture and timing of secondary surgery - a cohort study of 273 palms.

INTRODUCTION

Deep palmar burns in young children frequently cause disabling contractures. We aimed to identify the incidence, risk factors, and optimal timing of secondary surgery for surgically significant palmar contracture after split-thickness skin grafting in children under five years.

MATERIALS AND

METHODS

We conducted a retrospective study of all children <5 years with deep palmar thermal contact burns requiring skin grafting at a single pediatric burn center (2006-2021, minimum 5-year follow-up). All palms were uniformly resurfaced with thin, non-glabrous split-thickness skin grafts harvested from the scalp under a single institutional protocol.Exclusions included non-contact or dorsal injuries, incomplete data, and loss to follow-up. The primary outcome was scar contracture with functional impairment requiring corrective surgery; time to intervention was secondary. Multivariable Cox regression and Kaplan-Meier analysis identified risk factors.

RESULTS

Across 273 burned palms in 229 children (mean age at burn 16.5 months, 55.7% male), 125 hands (45.8%) developed a palmar contracture requiring secondary surgery. After adjustment, first web space involvement (HRa 4.45) and third-degree depth (HRa 1.93) were independent predictors, and metacarpal head involvement was protective (HRa 0.32). Referral to a specialized rehabilitation center was also associated with contracture (HRa 1.95) but is best interpreted as a marker of initial burn severity rather than an independent predictor. Mean time to surgery among affected cases was 3.2 years, earliest for hypothenar and first web space involvement.

CONCLUSION

Surgical contracture is common after deep palmar burns in young children, especially with first web space involvement and severe burns. Early risk stratification enables targeted surveillance and intervention, and may help improve patient outcomes. These findings apply to palms resurfaced with thin split-thickness skin grafts; the uniform protocol did not allow comparison with full-thickness or glabrous grafts, which remain alternative options.