Hand burns can cause major injuries and dysfunction even if small. Treatment involves first cooling the burn, evaluating size and depth, performing escharotomy or fasciotomy if needed, proper dressing, and early functional rehabilitation including physical therapy and splinting. The goals are to avoid additional injury, achieve early wound closure, maintain active motion, prevent infection, and facilitate social and professional reintegration.

1. HAND BURNS Dr. med. Camillo Müller,
CHUV

2. INTRODUCTION
FREQUENT OR IMPORTANT ?
HAND BURNS, 1926 - 1957, 1954b (Günter Germann)

3. INTRODUCTION
80 % of all sever burned patients
American Burn Association: major injury
Even small injury -> sever dysfunction
Evaluation of environment, communication, emotional signals, sexuality
social and professional reintegration

4. INTRODUCTION
TRAUMA
FIRST-AID
SURGERY
REHEBILITATION

5. TRAUMA
• dorsum of the hand: flame, explosions
• palm: chemical exposure, friction, high-voltage
• dorsal skin vs. palmar skin (IPP)

6. TRAUMA
• Mr Nicolet

7. FIRST-AID
• Cooling! 30 min tab water
• Patient history
• Escharotomy // Fasciotomy
• Casting at day of injury
• Multidisciplinary
(Plastic surgeons, Physical and occupational therapist, Psychologist )

8. FIRST-AID

9. FIRST-AID
Treatment goal:
- avoid any additional injury
- achieve early wound closure
- maintain active motion
- prevent infection
- early functional rehabilitation

10. FIRST-AID
Treatment principles:
- evaluate size and depth
- perform escharotomy (fasciotomy)
- proper dressing
- manage burn surgically
- physical therapy
- perform correction if necessary

11. FIRST-AID
Time saver:
Glove with silver sulfadiazine
(Goretex)

12. FIRST-AID
Mr. Nicolet

13. SURGERY
• Blisters?
• Escharotomy?

14. ESCHAROTOMY

15. SURGERY
• After debridement: hemostasis with Epinephrine (Bleeding)
• Interrupted stiches, metal skin staples (!!)
• Mesh graft: precision!

16. SURGERY

17. SURGERY

18. SURGERY
Mr. Nicolet

19. COMPLICATION
• Secondary infection
• Graft loss
• Early Hyper granulation

20. REHABILITATION

21. REHABILITATION
• Compression: from two weeks to 6 month

22. REHABILITATION
Mr. Nicolet

23. TAKE HOME
MESSAGE
• major Injury
• escharotomy
• early rehabilitation
• splinting
• compression

24. DISCUSSION