Objectives
Glabrous burns are a unique subtype of burns and are challenging to manage due to the unique histological, functional and aesthetic properties. A 36 year old, african male presented with bilateral full thickness open flame burns. Following the plastics principle of "replacing like with like tissues", we opted to trial a glabrous skin graft in order to maximise function, minimise disfigurement, restore appearance and normal anatomical structure.
Methods
The patient underwent a staged reconstruction of the plantar surfaces. The first surgery consisted of an autograft from the left thigh to the plantar surface for wound bed preparation. During the second surgery the non-glabrous autograft from the left foot was peeled off. Glabrous skin was harvested from the right foot with a dermatome at 0.45mm. The donor skin was meshed 1:3 and was clipped in placed onto the wound. The wound was dressed with paraffin gauze and dry dressings. Wounds were exposed on day 5.
Results
At one month post graft the wound is completely healed with hyperpigmentation and peeling off hyperkeratotic skin. Hyperpigmentation can be attributed to the migration of melanocytes from the initial autograft. There was adequate restoration of function and reasonable aesthetics. Donor sites are completely healed. At 5 month follow up the wound is smooth with recontouring and fill out of the recess, return of sensation and exposure to surfaces without marked sensitivity. Donor site wounds are no longer distinguishable. At the periphery of the non glabrous skin graft on the right foot we noted ealry hyperkeratotic scar formation. Patient complained of intermittent parasthesia of the right foot. Nil complaints of the left foot.
Conclusion
The histological differences give glabrous skin its characteristic function, allowing for increased durability to pressure and shear force, as well as ability to adapt to changes in surface contours. These highlight the advantageous indication for using glabrous skin. The use of non-glabrous skin complicates with hyperkeratotic scarring, contractures and subfibrotic tissue. This case reports demonstrates successful use of glabrous skin for treatment of full thickness plantar burns and despite misconceptions there was no donor morbidity. Thus we conclude that replacing like with like tissue yields superior outcomes resembling virgin skin anatomically, functionally and aesthetically.

7 - Glabrous Skin Graft for Bilateral Full Thickness Plantar Burns