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Primary operative management of hand burns

Samuel P Mandell, MD, MPH, FACS
Matthew B Klein, MD, MS, FACS
Section Editors
Marc G Jeschke, MD, PhD
Charles E Butler, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Over 80 percent of severe burn injuries involve the hand and thus have a tremendous impact on daily function and quality of life [1]. Effective treatment of hand burns requires a multifaceted and interdisciplinary approach that includes burn surgeons, plastic surgeons, rehabilitation physicians, and physical therapists.

The initial surgical approach to the patient with a burned hand, including the primary and secondary assessment and primary operative management, are discussed here. Surgical techniques used for primary coverage of burns (eg, skin grafts, free flaps) are also used for reconstruction of burns. The principles of reconstruction and operative procedures for secondary or delayed reconstruction of burns to the hands are reviewed elsewhere. (See "Principles of burn reconstruction: Extremities and regional nodal basins", section on 'Hand'.)


The initial evaluation of the patient with a hand burn begins with a thorough history and physical examination. Information about the mechanism of injury and the circumstances surrounding the injury may provide insight into the potential depth of the burn and healing capacity. The patient's hand dominance, occupation, and prior hand injuries should also be ascertained.

The focus of the physical examination is to estimate the severity and depth of injury as well as the viability of the hand and digits. Adequate hand perfusion is present if the radial and ulnar pulses are palpable; Doppler assessment should be done if pulses are not palpable. Each digit should be evaluated separately for perfusion by Doppler [2]. Patients at greatest risk for loss of perfusion are those who have full thickness burns, circumferential burns, or associated crush injuries and lacerations.

Signs of poor perfusion include [2-6]:

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Literature review current through: Nov 2017. | This topic last updated: May 03, 2017.
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