Elsevier

Hand Clinics

Volume 25, Issue 4, November 2009, Pages 551-556
Hand Clinics

Microsurgical Reconstruction of the Burned Hand

https://doi.org/10.1016/j.hcl.2009.06.009Get rights and content

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Acute thermal injuries

After initial management and resuscitation, early excision is performed for all third and fourth degree hand burns. Clearly nonviable tissue is removed. Questionable tissue may be left initially, then reevaluated and excised at a second-look procedure as needed. Once wound evolution is complete, the nature of the wound is examined. If tendons, bone, or nerves are exposed, skin graft coverage alone will be inadequate. Local, distant, and free flaps should be considered at this time. Given the

Electrical injuries

High-voltage electrical injuries commonly require microvascular reconstruction. These injuries frequently involve the hand and forearm as points of entry or contact. As with all high-voltage electrical injuries, the outer wound may only reveal a small fraction of the total destruction. Because of severe tissue destruction, limb salvage may be the primary goal in many of these patients. The muscles adjacent to the bones are commonly injured, as are nerves and blood vessels. Serial debridement is

Unstable Wounds

Patients sustaining large TBSA (total body surface area) burns often have portions heal by secondary intention, or they have thinner, widely meshed grafts placed on their hands as skin may not be available for coverage. As the patients resume their activities, problems with wound breakdown in their hands may occur. Frequently, these will respond to local wound care. However, in a subset of patients the breakdown is chronic, leading to increasing inflammation and scar contracture. If free tissue

Summary

Most routine hand burns can be managed without microsurgical techniques. Severe third and fourth degree hand burns or electrical injuries with exposure of nerves, tendons, or bones require microsurgical treatment if local tissue is insufficient or injured. Microsurgical reconstruction plays an important role in delayed reconstruction because it allows the surgeon to bring in vascularized tissue to scarred, unstable areas. Uncomplicated wound healing can occur over joint or tendon reconstruction

Acknowledgments

We gratefully acknowledge Dr. Kenneth Yim for his assistance in digitizing photographs of Fig. 14, Fig. 15, Fig. 16.

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