The burned hand. Early treatment and surgery of scars and contractions

Hand burns are common injuries in which early accurate diagnosis of the severity of the injury and active surgical treatment can save it or diminish the permanent disability caused by the thermal trauma. During the four year period of 1976--1979 we treated 45 patients with acute hand burns; secondary surgery was performed in 29 scarred and contracted hands. Deep dermal or subdermal (III degree) burns were either immediately excised to the vital tissue (within 6 hr postburn) or early afterwards (within 1--7 days post injury). The reconstruction of the excised areas was made by free skin grafting in 43 hands. If deep structures were exposed, subsequent reconstructions were used: local, groin, or free flaps. The aims in treatment of scarred hands were to restore function and to repair unstable scars. The following secondary procedures, often combined in a one-stage operation, were performed: scar excision and regrafting, web space correction, groin flap reconstruction, digital joint arthrodesis or capsulectomy, tendon transfer, and spherical osteotomy.