Recalcitrant Bilateral Volar Hand Burn Contracture in a Toddler Treated With Integra and Staged Full-thickness Skin Graft: A Literature Review.

Background: Recurrent burn contractures on the volar aspect of the hand present a formidable challenge, especially in the pediatric patient. We used Integra followed by staged full-thickness skin grafting for recurrent bilateral volar hand burn contracture in a toddler. We reviewed the literature to appraise the utility of full-thickness skin graft (FTSG) combined with Integra used for volar hand contractures.

Methods: A systematic review of the world's literature was conducted identifying publications on the application of Integra and skin substitutes for palmar hand contractures and wounds, to include burn injuries. We describe a case of a pediatric patient with recurrent bilateral burn flexion contracture of the palm and digits treated with scar excision and application of Integra, followed by staged application of FTSG.

Results: We identified 92 publications pertaining to volar hand defects or contractures managed with skin grafts, skin substitutes, and/or flaps. Ten articles referred to the use of Integra on volar hand wounds or contractures, and only 2 articles used FTSG instead of split-thickness skin graft in combination with Integra. Our systematic review of volar burn injuries of the hand and fingers demonstrated that the use of Integra combined with FTSG for postburn flexion contracture of the hand has not been previously reported.

Conclusions: This case report suggests that application of FTSG instead of split-thickness skin graft to vascularized Integra offers protective value against recurrent burn contracture of the palmar hand, but more studies are needed to support our hypothesis.