[Severe hand burns and flaps: indications]

Deep hand burns often leads to major deformities, involving cosmetic and functional disease as scar contracture, stiffness, or even amputation. Early surgical treatment and rehabilitation are always challenging but crucial in order to prevent burn sequelae. When tendinous, osseous, nervous or vascular component are involved, even hand vitality is engaged: cutaneous, fasciocutaneous, muscular or musculocutaneous flaps are then the only way of salvage for the hand. The purpose of this surgery is the early covering of essential components, allowing early rehabilitation and mobilisation. The problem remains the choice of surgical covering, according to the site, size, and depth of the burn, and local reliable opportunities. Care must be taken to preserve surgical ways for final sequela reconstruction.