Making the burned hand functional

The goal of treatment of the burned hand is to make the hand functional at the conclusion of treatment. Function should ideally include both fine pinch and power grip but will ultimately be determined by the individual patient's needs. At no time, however, can the care of the burned hand be performed in a vacuum, losing sight of the patient as a whole. It must also be remembered that the hand functions as part of the upper extremity. Full hand motion is useless if significant contractures of the elbow or axilla prevent the patient from positioning the hand so that this motion can be utilized. Rehabilitation must render the entire extremity functional. Thus, it becomes obvious that a team effort is mandatory. This usually will include the following individuals: physician, nurse, occupational therapist, physical therapist, vocational rehabilitation counselor, and social worker. A functional upper extremity means that the goal must be to return patients to their preburn vocations and avocations. A clear understanding of job requirements and work habits will allow realistic goals to be established. However, when the goal of optimal function cannot be reached, early retraining will help to obtain optimal rehabilitation.