Management of hand burns using tangential excision and grafting versus delayed excision and grafting

Abstract

Background: A burn injury to the hand, whether in isolation or associated with a major systemic burn injury, continues to be a challenge to the treating surgeon, as correct clinical judgment and decision regarding management thereof can affect the final outcome both aesthetically and functionally.Methods: A total of 84 patients (140 hands) were covered under the study, bilateral hand involvement in 56 patients (80% of hands) and unilateral involvement in 28 patients (20% of hands). Each group had 42 patients each. All patients were admitted to the hospital within 48-96 hours of the injury and operated within 3-7 post injury day.Results: The skin graft take was much superior in the early excision group as compared to delayed excision group and hence resulted in decreased overall hospital stay. The functional and aesthetic outcomes were better achieved with less need of secondary surgical procedures. There were no major complications. Patients were followed up for a period ranging from six to twenty four months.Conclusions: The skin graft take was much superior in early excision group as compared to delayed group and hence resulted in decreased overall hospital stay. The functional and aesthetic outcomes were better achieved and the needs for secondary surgical revision were far lesser with early excision and grafting. Both early excision and grafting, and delayed excision and grafting modalities lead to post-burn deformities of hand, albeit different from each other, but more common with delayed grafting.