Prevalence of stump overgrowth in pediatric burn patient amputations

Abstract

Background: Pediatric patients sometimes require amputation as part of their life-saving burn care. Bone overgrowth is known to occur in these amputation patients at rates of 4% to 43% depending on the study.

Methods: We conducted a retrospective study of all patients who underwent amputation at a children's burn center for a 45-year span. There were 18,880 burn patients during this time frame and 149 pediatric patients with amputation who survived long-term were studied. Burn types included flame, electrical, scald, thermal, and combination types in order of prevalence. We studied bone overgrowth as defined as those children requiring revision surgery.

Results: One hundred forty-nine patients underwent a total of 259 amputations. The average age at the time of amputation was 7.48 years. Stump overgrowth occurred in 15 patients (10.1%) or 15 of the 259 amputations (5.8%) overall. Bone overgrowth occurred in 11 of 104 flame burn patients (10.6%), 3 of 32 electrical burns (9.4%), and 1 of 9 scald burns (11.1%). Many patients had multiple amputations so the incidence for amputations was 6.1% (11 of 179) for flame, 5.4% (3 of 56) for electrical, and 5.9% (1 of 17) for scald burns. The mean time to overgrowth from primary amputation to revision surgery was 41.5 months. Overgrowth was more common in the lower extremities (17 of 104, or 16.3%) than in the upper extremities (3 of 153, or 2%).

Conclusions: Bony overgrowth after amputation in pediatric burn patients occurs at a rate of 10.1% of patients or 5.8% of amputations. Younger children are more likely to have overgrowth. The type of burn does not influence overgrowth and lower extremity amputations are more likely to show overgrowth than upper extremities.

Level of evidence: Level IV, case series.