Flap-sparing approach to pediatric hand wound management with acellular dermal matrix, skin grafting and vacuum-assisted closure: a case report

Severe pediatric hand injuries with exposed tendons and vessels have traditionally been managed using flap coverage. Flap surgeries in young children can be technically demanding, associated with donor site morbidity. Emerging evidence supports alternative reconstructive strategies using dermal substitutes and advanced wound therapies. We report a case of a 3-years-old male with a 3×2 cm anterolateral hand laceration exposing thenar muscles, tendons and vessels following road traffic trauma. Initial primary closure failed. The wound was managed with debridement, application of vacuum-assisted closure (VAC) therapy, placement of an acellular dermal matrix (ADM), split-thickness skin grafting (STSG) and VAC reapplication. Functional and aesthetic outcomes were documented. The wound healed with complete graft take and without the need for flap coverage. The patient regained full hand function with satisfactory cosmetic appearance. No complications such as infection, graft loss or contracture were noted at 1 month follow-up. The ADM facilitated neodermis formation over exposed tendons, allowing successful skin grafting. ADM combined with STSG and VAC therapy provided an effective alternative to flap surgery for pediatric hand wounds with exposed structures. This method can simplify management, reduce morbidity and preserve excellent functional outcomes in young patients.