Evaluation of early excision of dorsal burns of the hand

To determine the best method for treating deep second- and third-degree burned hands in our institution, a prospective study comparing early excision and grafting with nonsurgical treatment was undertaken. The patients were randomly assigned to two groups, and the hands in the first group were excised and grafted within 5 days after the burn. In the second group, burns were treated with topical chemotherapy and hydrotherapy, and the eschar was allowed to separate spontaneously and heal. Some required skin grafting, forming a subgroup. All hands in the study received the same vigorous physical therapy twice daily, and splints were applied according to the patient's individual needs to maintain an anti-deformity position. Grip strength, power pinch, and accurate range-of-motion measurements of each finger joint were measured upon discharge and 1, 2, 3, 6, and 12 months after the burn. A mean total degrees of motion (including flexion and extension) in each joint and strength values were determined for comparison among the three groups. At discharge, the spontaneously healed hands had the best range of motion and function. Although the rate of improved function was greatest in the interval from discharge to 6 months in all groups, by 1 year there was no statistical difference in function regardless of the initial treatment. Thus in deep second- and third-degree burns of the dorsum of the hand, care may be individualized according to other systemic factors without fear of sacrificing ultimate function.