Microsurgical Reconstruction of the Burned Hand
Section snippets
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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Cited by (7)
Microsurgical Reconstruction of the Burned Hand and Upper Extremity
2017, Hand ClinicsCitation Excerpt :Initial resuscitation, early excision of burned tissues, prevention of burn wound sepsis, and wound coverage remain mainstays of care. Although the majority of burn wounds can be covered with skin grafts, many of these wounds require complex reconstruction.1 This is particularly important in the hand, where a small cross-sectional area contains multiple specialized structures that when burned lead to devastating injuries, resulting in loss of hand function and permanent disability.
Scar Management of the Burned Hand
2017, Hand ClinicsCitation Excerpt :Full-thickness skin grafts are preferred over split-thickness graft because of the decreased effect of secondary contraction to minimize scarring (see Fig. 3). If the contracture release leads to exposed tendon or bone, local or distant flaps may be required.49 The extensor tendons dorsally often benefit from a fascia-only reverse radial forearm flap with a skin graft for coverage or a reverse dorsal interosseous flap.
Hand burns
2019, Handbook of BurnsManagement of Hand Burn with Pedicled Converted Anterolateral Thigh Free Flap
2019, Plastic Surgical NursingBurns
2015, The Pediatric Upper Extremity