From Scar to Function: Plastic Surgery in the Management of an Extreme Hand Contracture in a Child

Children are more prone to develop post-burn contractures than adults, even when optimal initial burn care is provided. In severe cases, such contractures may lead to significant deformities and functional impairments. We present a case of a pediatric patient referred to a plastic surgeon at the age of two by his parents, a few months after sustaining third-degree burns to both hands. Although the burns had healed, extensive scarring resulted in severe contractures, leaving the child's hands tightly clenched and preventing him from extending, flexing, or moving his fingers, thereby severely impairing hand function. A multi-stage surgical plan was established to release the contractures and restore hand function. Over a six-year period, five reconstructive procedures were performed, two on the left hand and three on the right. The surgical strategy incorporated full-thickness skin grafts (FTSGs), multiple Z-plasties, dorsal pentagonal island flaps, Z-plasties, and the use of Kirschner wires to maintain finger extension following passive joint release and contracture correction. This staged approach resulted in the successful restoration of hand functionality and an aesthetically favorable outcome. The postoperative course was uneventful, with minimal pain and no complications. Beyond the physical reconstruction, the regained hand function significantly contributed to the child's developmental progress, enhancing autonomy, promoting social interaction, and markedly improving overall quality of life.