Klimeczek-Chrapusta Maria, Chrapusta Anna
Faculty of Medicine, Jagiellonian University Medical College, Kraków, POL.
Malopolska Burn and Plastic Surgery Center, Ludwik Rydygier Memorial Hospital, Kraków, POL.
Cureus. 2025 Sep 12;17(9):e92121. doi: 10.7759/cureus.92121. eCollection 2025 Sep.
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.
儿童比成人更容易发生烧伤后挛缩，即使给予了最佳的初始烧伤护理。在严重的情况下，这种挛缩可能会导致明显的畸形和功能障碍。我们介绍了一例儿科患者的病例，该患儿在双手遭受三度烧伤几个月后，于两岁时被父母转诊给一位整形外科医生。虽然烧伤已经愈合，但广泛的瘢痕形成导致了严重的挛缩，使孩子的双手紧握，无法伸展、弯曲或移动手指，从而严重损害了手部功能。制定了一个多阶段的手术计划来松解挛缩并恢复手部功能。在六年的时间里，进行了五次重建手术，左手两次，右手三次。手术策略包括全厚皮片移植（FTSGs）、多次Z成形术、背侧五边形岛状皮瓣、Z成形术，以及在被动关节松解和挛缩矫正后使用克氏针来保持手指伸展。这种分阶段的方法成功地恢复了手部功能，并取得了美观的效果。术后过程顺利，疼痛轻微，无并发症。除了身体重建外，恢复的手部功能对孩子的发育进程有显著贡献，增强了自主性，促进了社交互动，并显著提高了整体生活质量。
