Advertisement

Hand Burns

  • Clifford C. Sheckter
  • Matthew B. Klein
Chapter

Abstract

Loss of hand function is the leading cause of impairment following burn injury. With majority of severe burns routinely survivable today, understanding the unique features of hand burn treatment is crucial for all burn surgeons. After trauma survey and resuscitation, evaluation for distal hand perfusion and appropriate upper extremity escharotomy ± fasciotomy are the first steps in managing hand burns. As with all burns, the principle of early excision and grafting yields the best results in limiting scarring and contracture. Splinting and aggressive therapy are paramount in maintaining hand function. For inevitable contractures, tailored techniques with local and regional flaps can restore hand function.

Keywords

Hand burns Extremity burns Acute care 

References

  1. 1.
    Luce EA. The acute and subacute management of the burned hand. Clin Plast Surg. 2000;27(1):49–63.PubMedGoogle Scholar
  2. 2.
    Anzarut A, Chen M, Shankowsky H, Tredget EE. Quality-of-life and outcome predictors following massive burn injury. Plast Reconstr Surg. 2005;116(3):791–7.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Arnoldo B, Klein M, Gibran NS. Practice guidelines for the management of electrical injuries. J Burn Care Res. 2006;27(4):439–47.PubMedCrossRefGoogle Scholar
  4. 4.
    Orgill DP, Piccolo N. Escharotomy and decompressive therapies in burns. J Burn Care Res. 2009;30(5):759–68.PubMedCrossRefGoogle Scholar
  5. 5.
    Salisbury RE, Taylor JW, Levine NS. Evaluation of digital escharotomy in burned hands. Plast Reconstr Surg. 1976;58(4):440–3.PubMedCrossRefGoogle Scholar
  6. 6.
    Burd A, Noronha FV, Ahmed K, Chan JYW, Ayyappan T, Ying SY, et al. Decompression not escharotomy in acute burns. Burns. 2006;32(3):284–92.PubMedCrossRefGoogle Scholar
  7. 7.
    Tambuscio A, Governa M, Caputo G, Barisoni D. Deep burn of the hands: early surgical treatment avoids the need for late revisions? Burns. 2006;32(8):1000–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Goodwin CW, Maguire MS, McManus WF, Pruitt BA. Prospective study of burn wound excision of the hands. J Trauma. 1983;23(6):510–7.PubMedCrossRefGoogle Scholar
  9. 9.
    van Zuijlen PP, Kreis RW, Vloemans AF, Groenevelt F, Mackie DP. The prognostic factors regarding long-term functional outcome of full-thickness hand burns. Burns. 1999;25(8):709–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Edstrom LE, Robson MC, Macchiaverna JR, Scala AD. Prospective randomized treatments for burned hands: nonoperative vs. operative. Preliminary report. Scand J Plast Reconstr Surg. 1979;13(1):131–5.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Albino FP, Fleury C, Higgins JP. Putting it all together: recommendations for improving pain management in plastic surgical procedures: hand surgery. Plast Reconstr Surg. 2014;134(4 Suppl 2):126S–30S.PubMedCrossRefGoogle Scholar
  12. 12.
    Klein MB, Hunter S, Heimbach DM, Engrav LH, Honari S, Gallery E, et al. The Versajet water dissector: a new tool for tangential excision. J Burn Care Rehabil. 2005;26(6):483–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Rennekampff H-O, Schaller H-E, Wisser D, Tenenhaus M. Debridement of burn wounds with a water jet surgical tool. Burns. 2006;32(1):64–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Herter F, Ninkovic M, Ninkovic M. Rational flap selection and timing for coverage of complex upper extremity trauma. J Plast Reconstr Aesthet Surg. 2007;60(7):760–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Fletcher JL, Cancio LC, Sinha I, Leung KP, Renz EM, Chan RK. Inability to determine tissue health is main indication of allograft use in intermediate extent burns. Burns. 2015;41(8):1862–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Smith MA, Munster AM, Spence RJ. Burns of the hand and upper limb—a review. Burns. 1998;24(6):493–505.PubMedCrossRefGoogle Scholar
  17. 17.
    Chandrasegaram MD, Harvey J. Full-thickness vs split-skin grafting in pediatric hand burns—a 10-year review of 174 cases. J Burn Care Res. 2009;30(5):867–71.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Schwanholt C, Greenhalgh DG, Warden GD. A comparison of full-thickness versus split-thickness autografts for the coverage of deep palm burns in the very young pediatric patient. J Burn Care Rehabil. 1993;14(1):29–33.PubMedCrossRefGoogle Scholar
  19. 19.
    Moisidis E, Heath T, Boorer C, Ho K, Deva AK. A prospective, blinded, randomized, controlled clinical trial of topical negative pressure use in skin grafting. Plast Reconstr Surg. 2004;114(4):917–22.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Palmieri TL. Initial management of acute pediatric hand burns. Hand Clin. 2009;25(4):461–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Scott JR, Costa BA, Gibran NS, Engrav LH, Heimbach DH, Klein MB. Pediatric palm contact burns: a ten-year review. J Burn Care Res. 2008;29(4):614–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Mohammadi AA, Bakhshaeekia AR, Marzban S, Abbasi S, Ashraf AR, Mohammadi MK, et al. Early excision and skin grafting versus delayed skin grafting in deep hand burns (a randomised clinical controlled trial). Burns. 2011;37(1):36–41.PubMedCrossRefGoogle Scholar
  23. 23.
    Agir H, Sen C, Alagöz S, Onyedi M, Isil E. Distally based posterior interosseous flap: primary role in soft-tissue reconstruction of the hand. Ann Plast Surg. 2007;59(3):291–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Karanas YL, Buntic RF. Microsurgical reconstruction of the burned hand. Hand Clin. 2009;25(4):551–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Baumeister S, Köller M, Dragu A, Germann G, Sauerbier M. Principles of microvascular reconstruction in burn and electrical burn injuries. Burns. 2005;31(1):92–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Lou RB, Hickerson WL. The use of skin substitutes in hand burns. Hand Clin. 2009;25(4):497–509.PubMedCrossRefGoogle Scholar
  27. 27.
    Haslik W, Kamolz L-P, Nathschläger G, Andel H, Meissl G, Frey M. First experiences with the collagen-elastin matrix matriderm as a dermal substitute in severe burn injuries of the hand. Burns. 2007;33(3):364–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Callcut RA, Schurr MJ, Sloan M, Faucher LD. Clinical experience with alloderm: a one-staged composite dermal/epidermal replacement utilizing processed cadaver dermis and thin autografts. Burns. 2006;32(5):583–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Fufa DT, Chuang S-S, Yang J-Y. Postburn contractures of the hand. J Hand Surg Am. 2014;39(9):1869–76.PubMedCrossRefGoogle Scholar
  30. 30.
    Moore ML, Dewey WS, Richard RL. Rehabilitation of the burned hand. Hand Clin. 2009;25(4):529–41.PubMedCrossRefGoogle Scholar
  31. 31.
    Lowell M, Pirc P, Ward RS, Lundy C, Wilhelm DA, Reddy R, et al. Effect of 3M coban self-adherent wraps on edema and function of the burned hand: a case study. J Burn Care Rehabil. 2003;24(4):253–8; discussion 252PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Schneider JC, Holavanahalli R, Helm P, O’Neil C, Goldstein R, Kowalske K. Contractures in burn injury part II: investigating joints of the hand. J Burn Care Res. 2008;29(4):606–13.PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Kamolz L-P, Kitzinger HB, Karle B, Frey M. The treatment of hand burns. Burns. 2009;35(3):327–37.PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Woolf RM, Broadbent TR. The four-flap Z-plasty. Plast Reconstr Surg. 1972;49(1):48–51.PubMedCrossRefGoogle Scholar
  35. 35.
    Eski M, Nisanci M, Sengezer M. Correction of thumb deformities after burn: versatility of first dorsal metacarpal artery flap. Burns. 2007;33(1):65–71.PubMedCrossRefGoogle Scholar
  36. 36.
    Donelan MB, Garcia JA. Nailfold reconstruction for correction of burn fingernail deformity. Plast Reconstr Surg. 2006;117(7):2303–8; discussion 2309PubMedCrossRefGoogle Scholar
  37. 37.
    Kurtzman LC, Stern PJ, Yakuboff KP. Reconstruction of the burned thumb. Hand Clin. 1992;8(1):107–19.PubMedGoogle Scholar
  38. 38.
    Lin S-Y, Chang J-K, Chen P-C, Mao H-F. Hand function measures for burn patients: a literature review. Burns. 2013;39(1):16–23.PubMedCrossRefGoogle Scholar
  39. 39.
    Kauvar DS, Wolf SE, Wade CE, Cancio LC, Renz EM, Holcomb JB. Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF/OEF explosion burns). Burns. 2006;32(7):853–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Zlotolow DA, Kozin SH. Advances in upper extremity prosthetics. Hand Clin. 2012;28(4):587–93.PubMedCrossRefGoogle Scholar
  41. 41.
    Iglesias M, Butron P, Moran-Romero M, Cruz-Reyes A, Alberu-Gomez J, Leal-Villalpando P, et al. Bilateral forearm transplantation in Mexico: 2-year outcomes. Transplantation. 2016;100(1):233–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Eberlin KR, Leonard DA, Austen WG, Yaremchuk MJ, Mudgal CS, Winograd JM, et al. The volar forearm fasciocutaneous extension: a strategy to maximize vascular outflow in post-burn injury hand transplantation. Plast Reconstr Surg. 2014;134(4):731–5.PubMedCrossRefGoogle Scholar
  43. 43.
    Garza RM, Press BH, Tyan DB, Karanas YL, Lee GK. Immunological effect of skin allograft in burn treatment: impact on future vascularized composite allotransplantation. J Burn Care Res. 2017;38(3):169–73.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Clifford C. Sheckter
    • 1
  • Matthew B. Klein
    • 2
  1. 1.Division of Plastic and Reconstructive SurgeryStanford School of MedicineStanfordUSA
  2. 2.Burn Center and Division of Plastic SurgerySanta Clara Valley Medical CenterSan JoseUSA

Personalised recommendations