Why do children's hands get burn contractures?

Young children often burn their palms by touching hot surfaces such as stoves, irons or heaters. Palm scars tighten as the hand grows, pulling the fingers into a bent position, so they need regular review and sometimes repeated releases during growth.

Why are full-thickness grafts used on the hand?

Full-thickness grafts contract less than split-thickness grafts and give more durable, better-matching skin, which matters for the palm and fingers.

Can joined fingers after a burn be separated?

Yes. Burn scars that web the fingers together can be released, using small flaps to rebuild the web and grafts on the sides of the fingers.

Will my fingers bend and straighten normally after surgery?

Movement usually improves considerably, but long-standing contractures can also stiffen the joints and tendons, which limits the final result. Early treatment and hand therapy give the most improvement.

Are wires used to hold the fingers straight?

Sometimes. Fine wires may temporarily hold a finger joint straight for a few weeks after release, especially in severe contractures.

When can I use my hand again?

Light use usually starts within the first weeks under the guidance of a hand therapist. Heavy gripping waits until the grafts are stable and the scar has settled.

Are both hands operated on at the same time?

Usually not, except sometimes in small children. Treating one hand at a time leaves the other free for eating, washing and toilet care.

Hand Burn Contracture Surgery in Pune

What is a hand burn contracture?

Hands are involved in many burns because we use them to protect ourselves and to handle hot objects. The skin on the back of the hand is thin and mobile, and the palm skin is thick and specialised, so scars behave differently in each area.

Common patterns include:

Back-of-hand (dorsal) contracture: the knuckles are pulled backwards and the fingers curl, giving a claw-like hand that cannot make a fist or open fully.
Palm and finger flexion contracture: fingers are held bent, often after contact burns in young children.
Thumb web contracture: the space between the thumb and index finger narrows, weakening grip and pinch.
Burn syndactyly: scar webs join the fingers together.
Nail and fingertip deformities after deeper burns.

Who may benefit, and how is it assessed?

Release is considered when a contracture limits grip, pinch, opening the hand or daily tasks, or when it affects a child’s hand development. The surgeon examines each finger joint, the thumb web and the palm, separates skin tightness from joint or tendon stiffness, checks sensation, and may arrange X-rays. In children, timing is planned around growth and the child’s ability to follow therapy.

What are the treatment options?

Option	Suits	Points to consider
Splints and hand therapy	During healing and for mild tightness	Prevents and reduces contractures
Z-plasty	Narrow bands across finger creases and web spaces	Gains length with no donor site
Release with full-thickness graft	Broad finger or palm contractures	Less contraction than split grafts
Local or distant flap	Exposed tendons or joints, thumb web	Durable cover; may need more than one stage
Web space reconstruction	Burn syndactyly and narrowed thumb web	Rebuilds the web with flaps and grafts
Temporary wires	Severe finger joint contractures	Holds joints straight for a few weeks

Grafting is described under skin grafting surgery, and scar softening under burn scar treatment. Tendon problems found during release are managed as in tendon repair surgery.

How is hand contracture release performed?

Anaesthesia: a regional block of the arm, or general anaesthesia, especially for children.
Release: tight scar is cut across or rearranged with Z-plasties, protecting nerves, vessels and tendons.
Joint release: tight joint capsules are freed if the joint itself has stiffened.
Cover: full-thickness grafts, usually from the groin or inner arm, or small flaps fill the gaps.
Splinting: the hand is splinted in a stretched, safe position, sometimes with temporary wires.

How should you prepare, and what should you ask?

Continue moisturising, massage and splints before surgery.
For children, plan school absence and help at home.
Plan regular hand therapy appointments for several months.

Questions to ask:

Which joints and webs need release?
Where will graft skin be taken from?
How long will splints be worn, and when can therapy start?
For a child: will more operations be needed as the hand grows?

What is recovery like?

Time	What to expect for most patients
Days 1-7	Hand raised in a bulky dressing and splint
Weeks 1-2	Graft checked; stitches removed; therapy begins
Weeks 2-6	Splints by day and night; exercises several times daily
Months 2-6	Night splints; scar massage; return to fuller use

What are the risks?

Recurrence of tightness, especially in growing children.
Partial graft loss or delayed healing.
Joint stiffness that does not fully resolve.
Colour difference between grafts and surrounding skin.
Donor-site scars in the groin or arm.

Contact the team for increasing pain, swelling, numbness, fever or a graft that darkens.

What results can you expect?

Most people gain better grip, a wider thumb web and easier opening and closing of the hand. Results depend on how long the contracture has been present, whether joints and tendons are involved, and commitment to splinting and therapy.

What happens if a hand burn contracture is left untreated?

When scar on the back of the hand holds the knuckles bent backwards, the fine balance of the finger tendons can be damaged beyond repair, so this pattern is one of the few released before the scar has fully matured. Fingers held curled by palm scar slowly develop stiff joint capsules and shortened tendons, and a narrowed thumb web steadily weakens pinch and the grasp of larger objects. In a young child, palm scar that is not stretched every day tightens further as the hand grows. Hand therapy, silicone, massage and resting splints remain worthwhile while the scar matures, and may be enough for mild tightness.

Common myths about hand burn contractures

“A child’s bent fingers will straighten out as the hand grows.” Palm scars usually tighten with growth, so children need regular review rather than a wait-and-see approach.
“Tying the fingers flat to a wooden scale at home works as well as a splint.” Improvised splints can cause pressure sores or hold the knuckles in a harmful position, so splints should be made and adjusted by a hand therapist.
“Fingers joined together by a burn have to stay that way.” Burn syndactyly can be separated, using small flaps to rebuild the web and grafts on the sides of the fingers.
“Hand therapy is optional once the operation is done.” Without months of splinting and exercises, released fingers often drift back into the old position.

What affects the cost of hand burn contracture surgery in Pune?

Number of fingers, webs and joints involved.
Technique: Z-plasty, full-thickness grafts, flaps or wires.
Anaesthesia and theatre time.
Splints and hand therapy sessions.

Hand Burn Contracture Surgery in Pune: Restoring Hand Function

Dr. Sushrut explains post burn contracture - hand