Management of Acute Hand Burns: A Survey of American Burn Association-Verified Burn Centers

Hand burns have a significant impact on the long-term function of burn patients. Recently, new protocols and technologies, such as dermal substitutes, have been introduced for the treatment of hand burns. This cross-sectional study investigates the preferred current management of acute hand burns and the role of dermal substitutes in treatment. A 10-question survey related to acute hand burns management was sent to 64 directors of American Burn Association (ABA)-verified burn centers. A total of 51.6% (n = 33) directors of ABA-verified burn centers responded to the survey. For the treatment of superficial partial-thickness hand burns, 90.9% preferred a nonoperative approach. Conversely, most respondents chose a single-stage excision and skin graft for deep partial-thickness hand burns (75.8%) and full-thickness hand burns (51.5%). However, for full-thickness hand burns, some surgeons prefer a 2-stage reconstruction involving excision and placement of a skin substitute (27.3%) or allograft (9.1%), followed by a skin graft. Only 6.1% would utilize a 3-stage reconstruction involving excision and allograft, excision and skin substitute, followed by skin grafting. Among surgeons who used skin substitutes (n = 26), Integra (42.3%) and Novosorb-Biodegradable Temporizing Matrix (23.1%) were preferred. The top reasons for choosing 1 specific dermal substitute were surgeon's preference (n = 20; 76.9%) and cost (n = 9; 34.6%). While a conservative nonoperative approach is preferred for superficial partial-thickness hand burns, excision and skin grafting as a 1-stage procedure remains the most common strategy for deep partial-thickness and full-thickness hand burns.