Surgery as an effective treatment for major hand burns.

26 Nov Surgery as an effective treatment for major hand burns.

The treatment of hand burns, like other medical pathologies, has evolved considerably in recent years. In the times in which we live, the priority is not only that the badly burned patient survives, but also that he or she does so with a good quality of life. Therefore, the treatment of hand burns is essential and must be early to avoid sequelae that could affect the patient functionally, socially and occupationally once he/she recovers.

In March 2014 I published an article in the professional journal “Wounds and Healing, along with other colleagues with whom I worked during my residency at the Hospital La Fe in Valencia, which reviewed how is the treatment to be followed in hand burns.

If you are interested in learning more about this topic, you can read the full article at Treatment of the burned hand. Optimal results with early surgery and rehabilitation. Page 16.

The importance of the hands and how to assess the burn.

Our hands are one of our most important life tools. They allow us to handle tools to work and manipulate objects, to express ourselves through gestures and writing, to touch and feel others. They are a very important part of our sensory system and therefore, emotional; without forgetting the great functionality of this part of the body. On the other hand, the hands are of great aesthetic importance, since it is a very visible region like the face, and can hardly be hidden under clothing. They are, in short, a complex organ of transcendental importance, which is why injuries cause great sensory and functional losses. And that can cause serious sequelae for patients in the long run.

For this reason, we must pay special attention to them from the beginning of the initial evaluation of the patient with burns , due to the consequences that may occur later if they go unnoticed.

It is very important to evaluate the depth of the burn at the precise moment it has occurred and we must repeat the evaluation frequently in the first few days. Especially in the case of circular or near-circular burns. With this evaluation on the table, we must decide if the burn can be resolved with a treatment of cures or, on the contrary, if it needs urgent surgery.

Causes leading to functional losses in the hands

There are multiple causes of functional loss in the hands and these are precisely the ones we must take into account in the management of the burn patient to ensure a good long-term functional future.

• The burn itself.
• Secondary edema, or swelling caused by fluid retention.
• Joint deformities that may be irreversible in the long run.
• Loss of soft tissue.
• Appearance of contractures, hypertrophic scars or infections.

Surgery as an effective treatment for hand burns and rehabilitation.

The main surgical treatment necessary in severe cases of hand burns is the so-called debridement, either by means of surgical instruments or chemical debridement drugs . This surgery should be performed during the first 5 days after the burn. It is a type of procedure that respects vulnerable structures of our hands such as tendons, blood vessels and nerves, and if possible the dermis; and favors recovery without sequelae.

In recent years, a new type of chemical debridant has appeared, called Nexobrid, which is applied with the patient under sedation or general anesthesia early in the first days after the burn, and which performs a selective debridement of the eschar, much more selective and precise than other conventional methods.

Rehabilitation

As for rehabilitation, it must be carried out from the beginning and progressively throughout recovery, by various means:

• Splinting and static orthoses, to maintain the functional position of the joints between rehabilitation sessions.
• Mobilization exercises.
• Performing the movements actively versus resistance.

Hand burns, one of the most common causes of morbidity in burn patients, are quite frequent, with a prevalence of 50% among burn patients in general and 80% in major burn patients. These burns are key to functional recovery, social and occupational reintegration, so their management is extremely important for the improvement of long-term prognosis.

An important part of our specialty is burns. In some reference centers for burns, such as the Burn Unit of La Fe, serious cases are treated either because of their great extension, their depth, or involvement of the face, hands, genitals, which require specialized and immediate attention.

I hope this article has been of interest to you. If you have any doubts you can contact me at any time, without obligation.