This study was undertaken to assess the incidence of contractures following grafting of pediatric hand burns. Primary pediatric hand burns grafted between January 1997 and July 2007 were reviewed by three groups: A) hand grafts (palmar and/or dorsal grafts excluding digits); B) digit grafts; and C) hand and digit grafts (grafts to palm and/or dorsum including digits). The incidence of contractures and operative release in those with full-thickness grafting (FTG) versus split-skin grafting (SSG) was analyzed. There were 174 grafted pediatric hand burns. In group A, the incidence of contractures with SSG was 26 vs 11% with FTG. Subgroup analysis revealed comparable contracture rates between palmar and dorsal grafts treated with SSG, 24 vs 25%. The only FTG contracture was a palmar graft. The incidence of contractures in digit grafts or group B was low, 3 of 29 with SSG and 0 of 27 with FTG. In group C, the incidence of contractures in the SSG group was 43%, with none in the FTG group, P = 0.019. This was higher with SSG to the palm and digits at 67 vs 21% with dorsal grafts. The study revealed an overall 34 of 126 (27%) incidence of contractures with SSG and 1 of 45 (2%) with FTG, P < 0.001. The incidence of operative scar release was 15% in the SSG group and 2% in the FTG group, P = 0.019. This study supports the use of FTG in the treatment of primary hand burns particularly where the burn involves the surface of the palm and extends into the digits.