Laser Doppler evaluation of burned hands predicts need for surgical grafting

Management of deep dermal hand burns represents a difficult clinical problem for the burn team because bedside estimation of burn depth is unreliable. Early identification of full-thickness injury and prolonged healing times might result in the decision to perform surgical excision of eschar and skin grafting of the wounds. Such a strategy may improve overall functional and cosmetic results of hand burn treatment. This report concerns a 2-year study of 31 patients with 43 burned hands using the LD6000 helium-neon laser Doppler flowmeter. After obtaining informed consent, burned areas of the hand were evaluated on days 1, 3, and 5 after burn. Results were reported as flow (mV), representing the quantity of moving erythrocytes multiplied by erythrocyte velocity in the capillary tissue. The reported volume in percentage of Doppler-shifted light represented only the quantity of moving erythrocytes. Median flow values in nongrafted hands were 150 mV; in those requiring skin grafts, median flow values were 89 mV. Flow values were significantly greater in nongrafted compared with grafted hand burns on days 1 and 5. Volume values were not associated with whether or not grafting was performed. Median volume values, however, did allow determination of whether the burns would spontaneously heal within 15 days (high group) or if a mean of 42 days would be required (low group). Functional and cosmetic outcomes were determined by retrospective chart review, which revealed comparable results regardless of grafting and regardless of short or prolonged healing times. Laser Doppler flowmetry may serve as a valuable adjunct to the prediction of the need for grafting and time to wound closure. Standardization of flowmetry data and techniques of evaluation are desirable. Spontaneous healing should be the goal in the majority of deep dermal hand burns.