Late results following treatment of deep burns of the hands

During a 10-year period, 467 patients with burns involving the hands have been treated, 290 of whom during the past 5 years. Two groups of patients were examined: the first were those who had received treatment between 1967 and 1971 using the exposure method and the reconstruction with skin grafts only after the spontaneous separation of the eschars, and the second, using the closed method and early or late excision of the necrotic tissue followed by covering with split-thickness grafts. In this second group are included also those patients whose burns can be classified as medium depth at the time of admission but in whom experience has shown that one is dealing with lesions with a tendency to become deeper during the post-burn period. For these cases a dermabrasion of the lesions was performed without covering with free grafts. In the cases subjected to surgery using the technique of tangential excision and dermabrasion in order to reach the more difficult areas such as the interdigital spaces, dermabrasion was only performed between the 2nd and the 28th day. The removal of the burned tissue was followed by covering with free grafts, except in those cases in which the depth was in doubt. The results obtained have demonstrated that in the first group the scars have led to serious invalidating consequences which have necessitated long and complex surgical reconstruction programmes. In the second group almost complete function has been restored with the aid of only minimal surgical correction, most often in the interdigital spaces. We would like to emphasize the usefulness of surgery in those cases on the borderline between medium and full thickness. The tendency of these lesions to become deeper has often led to scars which are very similar to those following the deep lesions.