Burns-Reconstructive Options of Burn Injuries to the Hand and Upper Extremity

Reconstructive Options of Burn Injuries to the Hand and Upper Extremity

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This article discusses the various reconstructive options for burn injuries to the hand and upper extremity. With advancements in critical care techniques, more burn patients are surviving their injuries, leading to a focus on preserving function and reducing morbidity. Despite skin grafting and wound coverage, many burn scars can limit function due to acquired contractures and syndactylies. Severely burned patients may require staged reconstructions and even amputations.<br /><br />Prevention is an important aspect of burn care, and early escharotomy and nerve decompression of the fingers, thumb, and hand are important strategies to preserve vascularity and decrease tissue pressures. Surgeons should be familiar with proper escharotomy technique to avoid complications such as nerve and vessel laceration.<br /><br />Subacute reconstruction involves covering exposed tendon, bone, or neurovascular structures with local or distant flap coverage. The choice of reconstruction depends on the availability of donor sites and the extent of the burn injuries.<br /><br />Late reconstruction is performed on patients seeking improvement in hand function that has been compromised by restrictive scars. One common area of late reconstruction is the first web space to relieve thumb adduction contractures and thumb-index web space syndactyly.<br /><br />Occupational therapy plays a crucial role in burn reconstruction and should be initiated early to improve range of motion and control edema. Additional adjuvants such as compression garments, silicone patches, and steroid injections can improve the appearance and quality of burn scars.<br /><br />The goal of burn reconstruction is to maximize early function, minimize deformity, maintain sensibility and dexterity, and prevent disability.

Keywords

reconstructive options

burn injuries

hand

upper extremity

function preservation

morbidity reduction

burn scars

contractures

syndactylies

staged reconstructions