Pediatric Postburn Flexion Contracture Release: Early Outcomes Using 2 Bloodless Techniques

Abstract

Abstract Postburn flexion contracture of the hand in children constitutes a significant proportion of postburn complications. We compared the early clinical outcomes of reconstruction of pediatric postburn flexion contracture of the digits of the hand using tourniquet or tumescent technique. A prospective randomized study of pediatric patients requiring contracture release and wound resurfacing with full-thickness skin graft between September 2020 and August 2021. Patients were randomized into groups of either tourniquet or tumescent technique for contracture release. The surface area of graft take and total active motion across joints were the outcome measures. Student t test and chi-square test were performed. Twenty-two patients were randomized into either group. The mean age of the participants was 6.09 ± 2.41 years, mostly males 31 (72.1%). A grade 3 flexion contracture was the most common (72.1%). Ninety-four digits and 178 joints were operated on, with the proximal interphalangeal joint being the most common (48.9%). The mean surface area of graft take on postoperative day 10 was significantly higher for the tumescent group than the tourniquet group, P = .001. The total active motion across the joints at 6 and 9 weeks postoperative showed a strong correlation between the total active motion across joints and the technique of release, P = .004 and .001, respectively. Tumescent technique is a feasible alternative to the tourniquet method for postburn flexion contracture release of the digits in the pediatric burned hand.