The Acute Burned Upper Extremity: Evolution of Practices and Management

Although limited to a small total surface area, burns to the hand can cause tremendous functional and social disability. The hand surgeon's reconstructive toolkit continues to evolve rapidly in light of improving burn mortality and technical advances. The surgeon should aim for the simplest reconstructive plan that facilitates early mobility and rehabilitation. Grafting (including the use of newer skin substitute agents), local and free flaps, and repair of underlying structures should prioritize key functional recovery over the complete range of motion. Multidisciplinary collaboration between the hand surgeon, burn team, and rehabilitation specialists is critical for achieving and maintaining optimal outcomes. In this review, we present an overview of the hand surgeon's role in assessment, acute surgical intervention, and postburn management for severe hand burns.