Acute and reconstructive care of the burned hand

Hands are commonly injured in burned patients. Optimal outcome is predicated on prompt and comprehensive action in diagnosing the depth of the burn, decompressing compartment syndromes, early and aggressive therapy, early excision and grafting, and coordinated secondary reconstructions. Rapid closure of hand burns is associated with better functional outcomes. Hand therapy is central to outcome and sufficient staff is central to care. When contractures occur, aggressive reconstruction can improve function. The most common debilitating pathology is insufficient skin coverage to allow proper range of motion. Surgical release results in a defect that can be covered with grafts or flaps. Electrical injuries commonly affect the hands. Total care of the burned hand is predicated on aggressive management and takes years to reach maximal medical benefit. Patients should be offered the full range of acute and reconstructive options in a comprehensive burn center environment.