Early excision of full-thickness hand and digit burns: factors affecting morbidity

Full-thickness dorsal hand and digit burns result in serious acute and chronic functional disability. Early wound closure is paramount to minimize functional impairment and improve ultimate cosmetic appearance. Fifty patients were followed for 2 to 6 years after excision and immediate autografting of full-thickness hand and digit burns. Based on the depth of injury distal to the metacarpal phalangeal joints, two groups of hand burns emerged in this series. Group I: Patients had uninjured and intact extensor mechanisms. Near normal range of motion was obtained by the end of the second postoperative week. Local wound sepsis and/or inadequate depth of excision resulted in autograft loss and additional surgical procedures in 10% of the hands. Group II: Patients with thermal damage to some portion of the extensor mechanism of the digit. Seventy-five per cent of these hands had thermal damage to bone. An average of three operative procedures was required on each hand for ultimate wound closure. Prolonged immobilization, persistent edema, and local wound sepsis were common to all Group II hands. Reconstructive surgery was necessary within 1 year in 43% of all hands. Hands in Groups I and II required surgery 12% and 75% of cases, respectively. Early surgical excision coupled with aggressive physical and occupational therapy has decreased but not eliminated many of the acute and chronic sequelae of full-thickness hand and digit burns.