Split-Thickness Skin Graft for Scar Release, Permanent Pigment Transfer, and Fractional CO2 Laser Therapy
Aleia M. Boccardi, DO¹; Robert J. Dabek, MD²; Lisa Gfrerer, MD, PhD³; Daniel N. Driscoll, MD, FACS^4
1St. John’s Episcopal Hospital
²Massachusetts General Hospital
³Harvard Plastic Surgery Combined Residency Program
⁴Shriners Hospitals for Children – Boston

Pediatric burns are one of the most common forms of injury affecting children worldwide. Of these, hand involvement occurs in 80–90% of such incidents. With the skin in children already diffusely thinner throughout the body than adults, this provides a particular challenge for areas naturally possessing thinner skin, such as the dorsal hand. There, the cutaneous tissue is the only protection for vital structures in the hand that allow full function, such as extensor tendons, nerves, and vessels. Injury to this area early in life can have a detrimental impact on how the survivor interacts with the physical world, affecting their functional capacity and quality of life.

Here presents a case of burn contractures on the right hand of an 8-year-old boy that will be released using a split-thickness graft, along with a pigment transfer graft for his left knee and fractional CO₂ laser therapy over areas of hypertrophic scar tissue on his bilateral upper extremities. The split-thickness graft will greatly decrease the tension built up from the burn contracture, while the fractional CO₂ laser procedure can soften the surrounding scar, allowing mild remodeling and increased range of motion.