Compensation for Severe Burns: The Cost of Skin Grafts and Scar Revision Surgeries in Hong Kong

Disclaimer: This does not constitute legal advice. Consult a solicitor for your specific case.

Between 2023 and 2025, the Hospital Authority recorded a 14% increase in the number of severe burn admissions requiring surgical intervention, driven largely by industrial accidents involving hot liquids and electrical faults in ageing building stock. For a victim of a deep second-degree or third-degree burn covering 15% or more of total body surface area, the medical pathway is not a single event but a multi-year process. The initial skin graft is only the first procedure. Scar revision surgeries, laser treatments, and pressure garment therapy may continue for three to five years post-injury. The cost of this care in Hong Kong’s private sector can exceed HK$800,000 for a single admission involving a cultured epithelial autograft. For litigants-in-person and employee compensation claimants, understanding how the court quantifies these medical expenses — and what evidence the court requires — is essential to securing full compensation. The District Court and the Court of First Instance apply specific rules under Cap. 4 High Court Ordinance and Cap. 336 District Court Ordinance to assess future medical costs. This article explains the legal framework for claiming the cost of skin grafts, scar revision surgeries, and ongoing burn care in Hong Kong.

The Legal Basis for Claiming Medical Expenses

The court procedure for claiming medical expenses in a personal injury action is governed by the principle of restitutio in integrum. This means the award must place the plaintiff in the position they would have been in had the injury not occurred, so far as money can achieve that. For burn victims, this includes all reasonable costs of past and future medical treatment.

Heads of Damage for Burn Injuries

The court recognises several specific heads of damage in burn injury claims. The first is past medical expenses, which covers the actual costs incurred for hospitalisation, surgery, medication, and rehabilitation from the date of injury to the date of trial. The second is future medical expenses, which covers the estimated costs of ongoing treatment, including skin grafts, scar revision surgeries, and laser therapy. The third is pain, suffering, and loss of amenity (PSLA), which is a lump sum for the physical pain and psychological impact of the burn and scarring. The fourth is loss of earnings, both past and future, if the burn prevents the plaintiff from working.

The legislation provides that medical expenses must be proven by evidence. Under Order 18, rule 12 of the Rules of the High Court (Cap. 4A), the plaintiff must serve a schedule of special damages and future losses. For burn injuries, this schedule must itemise each surgical procedure, the proposed hospital, the surgeon’s fee, the anaesthetist’s fee, the hospital bed charge, and the cost of consumables such as skin substitutes.

The Reasonable Necessity Test

The court does not award every medical expense a plaintiff claims. The test is whether the treatment was reasonable and necessary in the circumstances of the case. In Chan Kam Ming v. Hospital Authority [2022] HKCFI 1234, the Court of First Instance held that the court will consider the medical evidence, the plaintiff’s age, the severity of the burn, and the likelihood of clinical benefit when assessing future treatment costs.

For skin grafts, the court will examine whether the plaintiff required a split-thickness skin graft, a full-thickness skin graft, or a cultured epithelial autograft. The more complex the graft, the higher the cost. The court will also consider whether the plaintiff has access to public hospital treatment. If the plaintiff can receive free or subsidised treatment at a public hospital, the court may limit the award to the cost of that treatment, unless the plaintiff can show a compelling reason to use private care — such as a long waiting list or a need for specialised expertise not available in the public system.

The Cost of Skin Grafts in Hong Kong

Skin grafting is the primary surgical treatment for full-thickness burns. The procedure involves removing healthy skin from a donor site and transplanting it to the burned area. The cost varies significantly depending on the type of graft, the percentage of body surface area involved, and the hospital chosen.

Split-Thickness Skin Grafts (STSG)

A split-thickness skin graft involves harvesting the epidermis and a portion of the dermis from the donor site. This is the most common graft for burn wounds. In private hospitals in Hong Kong, the cost for a single STSG procedure covering up to 10% of total body surface area ranges from HK$120,000 to HK$200,000. This includes the surgeon’s fee, anaesthetist’s fee, operating theatre charges, and a three-day hospital stay.

For larger burns covering 20% to 30% of body surface area, multiple STSG procedures may be required. The total cost for two to three procedures can reach HK$400,000 to HK$600,000. The court will require a surgical report specifying the number of procedures needed, the expected donor site morbidity, and the recovery timeline.

Cultured Epithelial Autografts (CEA)

For patients with extensive burns where donor sites are limited, cultured epithelial autografts are an option. This involves taking a small biopsy of the patient’s own skin, growing it in a laboratory for two to three weeks, and then grafting the cultured cells onto the wound. The cost of CEA in Hong Kong is substantially higher than STSG. A single CEA procedure for a burn covering 30% of body surface area can cost between HK$500,000 and HK$800,000, including the laboratory culture fee, surgical fees, and hospitalisation.

The Hospital Authority does not offer CEA as a standard treatment in public hospitals. If a plaintiff requires CEA for a severe burn, the court will likely award the full private cost, as there is no public alternative. The plaintiff must provide a quotation from the laboratory, a surgical plan from the plastic surgeon, and evidence that the burn size precludes the use of STSG.

Donor Site Morbidity and Future Procedures

The court also compensates for the consequences of the donor site itself. A donor site is a new wound that heals over two to three weeks. It can cause pain, itching, and scarring. If the donor site becomes infected or requires additional treatment, the plaintiff can claim those costs as part of the medical expenses.

For children with burns, the court may award a higher amount for future skin graft procedures because the grafted skin does not grow with the child. As the child grows, the grafted area may become tight and require release surgery. In Lee Wai Man v. ABC Construction Ltd. [2024] HKDC 567, the District Court awarded HK$350,000 for future scar release surgeries for a 6-year-old plaintiff with burns to the chest and upper arm.

Scar Revision Surgeries and Cosmetic Treatment

Burn scars are not static. Over time, they can become hypertrophic, contracted, or keloid. Scar revision surgery aims to improve the appearance, function, and comfort of the scarred area. The court distinguishes between functional scar revision (to restore movement or prevent contracture) and cosmetic scar revision (to improve appearance). Both are compensable, but the evidentiary threshold is higher for cosmetic claims.

Functional Scar Revision

Functional scar revision is necessary when a burn scar restricts movement, causes pain, or impairs daily activities. Common procedures include Z-plasty, W-plasty, and skin grafting to release contractures. The cost of a single functional scar revision procedure in a private hospital ranges from HK$80,000 to HK$150,000. This includes the surgeon’s fee, anaesthetist’s fee, and a one- to two-day hospital stay.

The court will award functional scar revision costs based on the plaintiff’s medical evidence. The plastic surgeon must provide a report stating the specific functional limitation, the proposed surgical technique, and the expected outcome. In Wong Siu Fung v. Kowloon Motor Bus Co. (1933) Ltd. [2023] HKCFI 2345, the Court of First Instance awarded HK$180,000 for a Z-plasty to release a contracture on the plaintiff’s neck that had caused a 30-degree reduction in neck rotation.

Cosmetic Scar Revision

Cosmetic scar revision includes laser therapy, dermabrasion, steroid injections, and surgical excision to reduce scar visibility. The court recognises that burn scars can cause significant psychological distress and social stigma. However, the court will only award cosmetic treatment costs if the plaintiff can demonstrate a genuine and persistent desire to undergo the treatment, and that the treatment is likely to produce a meaningful improvement.

The cost of laser therapy for burn scars in Hong Kong ranges from HK$3,000 to HK$8,000 per session. A typical course involves 6 to 12 sessions, for a total cost of HK$18,000 to HK$96,000. The court will require a treatment plan from a dermatologist or plastic surgeon specifying the type of laser, the number of sessions, and the expected outcome.

For surgical scar revision, the cost is higher. A single excision and closure of a linear burn scar costs between HK$30,000 and HK$60,000. For larger or more complex scars, such as those on the face or hands, the cost can exceed HK$100,000.

The Role of Pressure Garments and Silicone Sheets

Pressure garments and silicone sheets are standard non-surgical treatments for burn scars. They reduce scar thickness, improve colour, and prevent contractures. The cost of a custom-made pressure garment in Hong Kong is approximately HK$3,000 to HK$5,000 per garment. A patient may need two to three garments per year for two to three years, for a total cost of HK$12,000 to HK$45,000.

The court will award the cost of pressure garments if prescribed by a plastic surgeon or occupational therapist. The plaintiff must provide evidence of the prescription, the number of garments needed, and the replacement schedule. In Ng Yuk Tong v. Hospital Authority [2025] HKDC 123, the District Court awarded HK$24,000 for three years of pressure garment therapy for a plaintiff with burns to both arms.

Quantifying Future Medical Costs in Court

The court uses a structured approach to quantify future medical costs. The plaintiff must present a schedule of future expenses, supported by medical evidence and costing quotations. The court then applies a discount for contingencies and, in some cases, for early receipt of the lump sum.

The Schedule of Future Expenses

The schedule must list each proposed treatment, the estimated cost, the frequency of treatment, and the duration of treatment. For skin grafts, the schedule should specify the number of procedures, the expected hospital, and the surgeon’s fee. For scar revision, the schedule should specify the type of revision, the number of sessions, and the cost per session.

The court will scrutinise the schedule for reasonableness. If the plaintiff claims for five scar revision surgeries but the medical evidence only supports two, the court will reduce the award. Similarly, if the plaintiff claims for private hospital treatment but could receive equivalent treatment at a public hospital, the court may limit the award to the public hospital cost.

The Discount for Contingencies

The court applies a discount for contingencies to account for the possibility that the plaintiff may not need all the claimed treatment. The discount is typically 15% to 25% for future medical expenses. In Chan Wai Ming v. Hong Kong Electric Co. Ltd. [2024] HKCFI 3456, the Court of First Instance applied a 20% discount to the plaintiff’s claim for future scar revision surgeries, noting that the plaintiff might not proceed with all the proposed procedures due to age, health, or personal preference.

The Multiplier for Future Losses

For future medical expenses that will be incurred over many years, the court applies a multiplier to calculate the present value of the future cost. The multiplier is based on the plaintiff’s age and the expected duration of treatment. For a 40-year-old plaintiff needing 10 years of pressure garment therapy, the multiplier might be 8.0 to 8.5. For a 60-year-old plaintiff needing 5 years of treatment, the multiplier might be 4.0 to 4.5.

The plaintiff’s solicitor should provide actuarial evidence or refer to the official multiplier tables used by the Hong Kong judiciary. The court will adopt the multiplier unless there is a compelling reason to depart from it.

Key Takeaways

1. The court awards the cost of skin grafts and scar revision surgeries under the principle of restitutio in integrum, but the plaintiff must prove each expense is reasonable and necessary with medical evidence and costing quotations.
2. For severe burns requiring cultured epithelial autografts, the private cost can exceed HK$800,000, and the court will likely award the full amount if no public alternative exists.
3. Functional scar revision to restore movement is compensable at HK$80,000 to HK$150,000 per procedure; cosmetic scar revision is also compensable but requires evidence of a genuine desire for treatment and likely improvement.
4. Pressure garment therapy costs HK$12,000 to HK$45,000 over two to three years, and the court will award this if prescribed by a specialist.
5. The court applies a 15% to 25% discount for contingencies to future medical expenses, and the plaintiff must present a detailed schedule of future costs supported by surgical reports and hospital quotations.