Comparative analysis of functional and aesthetic outcomes of retroauricular full thickness versus plantar glabrous split thickness skin grafts in pediatric palmar hand burns

Background: Optimal management of palmar hand burns in children is controversial. We aimed to compare function and aesthetics of retroauricular full thickness skin grafts (FTSG) to plantar glabrous split thickness skin grafts (STSG). Methods: 32 palmar grafts in paediatric burn patients were analysed: 19 retroauricular FTSG (group 1) and 13 thick plantar glabrous STSG (group 2). The latter were harvested at a thickness of 0.5 mm. The resulting plantar donor defects were covered with a STSG from the scalp, a sequential surgical technique we termed the "Zurich move". Clinical examination, Cutometer and Colorimeter assessment and validated patient and observer questionnaires were used. Donor site complications and subjective complaints were recorded. Results: Colorimeter results were superior in group 2 with an erythema score of 5.73 +/- 2.64 (group 1) versus 2.33 +/- 1.97 (group 2, p < 0.001) and a pigmentation score of 9.82 +/- 5.42 (group 1) and 1.89 +/- 1.92 (group 2, p < 0.001). Observers' scar evaluation using VSS and POSAS showed significantly superior results in group 2 for almost all items. Conversely, group 1 grafts were less stiff with mean normalized tissue extension R0 of 0.80 +/- 0.21 versus 0.57 +/- 0.24 in group 2 grafts (p < 0.05). In both groups donor sites complications were rare. Conclusion: Plantar glabrous STSG showed superior functional and aesthetic results when compared to FTSG in pediatric palmar hand burns. In addition, the "Zurich Move" is safe and provides uncomplicated donor site healing on the scalp and the foot allowing rapid restoration of full function. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.