Scar Revision and Skin Grafting for Burn Injuries on Hands

Burn injury on the dorsal side of the hand at the finger joints?

Hello Doctor, I sustained a second-degree burn on the joints of my fingers on the back of my hand at the end of February this year, and I underwent debridement surgery without skin grafting.
However, as of December, the scar is still quite thick.
I would like to ask if re-excising the scar and performing a skin graft would result in a flatter and less noticeable scar.

Xiao Zhang, 20~29 year old female. Ask Date: 2016/12/02

Dr. Zhou Hongzhang reply Plastic Surgery

1.
Burns on the dorsal side of the fingers are prone to developing severe scarring issues.
2.
If, after an injury, there is limited range of motion (ROM) in the fingers even after aggressive rehabilitation for one year, skin grafting surgery may be considered for treatment.
At this point, the focus should not be on cosmetic concerns, but rather on functional issues.

Reply Date: 2016/12/02

More Info

When dealing with burn injuries, particularly second-degree burns that have resulted in thick scarring, it is essential to understand the options available for scar revision and skin grafting. Based on your situation, where you have undergone debridement but not skin grafting, it is understandable that you are seeking ways to improve the appearance of your scar.

First, it is crucial to recognize that scars can change over time. Initially, scars may appear red, raised, or thick, but they often become less noticeable as they mature. However, in some cases, scars can remain thick and prominent, especially if there is a genetic predisposition to hypertrophic scarring or keloids. If your scar has not improved significantly over the months, you might consider surgical options.

Scar revision surgery is a procedure that involves removing the existing scar tissue and closing the wound in a way that minimizes the appearance of the scar. This can be particularly effective for thick scars, as it allows for the creation of a new scar that may heal better than the original. The new scar can be placed in a less noticeable location or aligned with natural skin lines to improve its appearance.

Skin grafting is another option that can be considered, especially if the scar is extensive or if there is a need for additional skin coverage. In this procedure, healthy skin is taken from another area of your body (the donor site) and transplanted to the scarred area. This can help to create a smoother, more even surface and can significantly improve the overall appearance of the hand.

However, it is important to have realistic expectations. While scar revision and skin grafting can improve the appearance of scars, they may not completely eliminate them. The success of these procedures can depend on various factors, including the size and location of the scar, your skin type, and how well your body heals.

Before proceeding with any surgical intervention, it is advisable to consult with a board-certified plastic surgeon or dermatologist who specializes in scar management. They can assess your scar, discuss your goals, and recommend the best course of action tailored to your specific situation. They may also suggest adjunctive treatments such as silicone gel sheets, pressure garments, or laser therapy to further improve the scar's appearance post-surgery.

In summary, scar revision and skin grafting can be effective options for improving the appearance of thick scars resulting from burn injuries. Consulting with a specialist will provide you with the necessary information and guidance to make an informed decision about your treatment options. Remember to discuss all your concerns and expectations during your consultation to ensure the best possible outcome for your scar management.

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