SEVERE BURNS HAND - THUMB WITH CONTRACTURES...

 Hello,

My daughter who is volunteering in Indonesia sent me a photo yesterday of a little girl with a deformed thumb from an untreated burn injury.  She is asking if anything can be done for the child.

I have attached some pictures.

My daughter writes, "L.. is a little over one year old and the first burn incident happened when she was about 4 months and the second incident happened when she was about 8 months (she rolled into the fire.)"

Can you make a recommendation whether or not surgical intervention would be of benefit to her?

Thanks for you time,

Dr D W

Dear Dr D W
Thanks you very much for your letter,
so sad to see this wonderful child suffer from this burn,
nice to hear your daughter is doing charity work abroad,

L...has a burn which is quite severe,
the burns must have been full thickness and would have needed a skin graft during the time of the burn episode ,
as no addition of tissue was done it healed secondarily causing very severe burn contractures,

presently the contracture is severe as it appears,

its has distorted the thumb joints and if untreated will end in severe deformities in the future and she will  be unable to effectively use the thumb,

she needs surgery which will involve ,

releasing the thumb from its present position and getting it back to its normal position,

once done i think a large area of tissue defect will appear and this may need a thick pad of tissue with skin ( flap cover as it is called in plastic surgery ) rather than a thin skin graft, 

choices of flaps include - radial artery flap, abdominal flap and free flap depending on the expertise available

sometimes if we are lucky we may be able to get away with a skin grafting procedure,(this can be made sure of only at surgery),

we at asktheburnsurgeon hope that this sweet child can be helped somehow to regain back her function ....

with best regards

and wishes

asktheburnsurgeon++