Scar Management of the Burned Hand

Abstract

Unimpaired hand function is critical in almost all activities of daily living. Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Initial algorithms of acute burn management involve early debridement and skin grafting and early mobilization to prevent formation of hypertrophic scarring and ultimately digit contractures. While non-operative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated in order to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation with several modalities that address scar texture, color, pruritis and thickness. These can be utilized in conjunction with local corticosteroid treatment and other emerging modalities to modulate the scar and achieve optimal hand function. These treatment tools provide an effective resource for the reconstructive surgeon to treat hypertrophic hand scars.

Scarring After Burn Injury

“…The neck is prioritised for early grafting not only for function but also to allow for tracheostomy placement as severely burned patients may require prolonged ICU stay and ventilation. Full-thickness burns on the dorsal aspect of the hands are grafted to allow early mobilisation and return to function, and early intervention by occupational and physiotherapists will improve outcome [27]. A good result for the hand dorsum is important since these scars are constantly in the field of vision and poor results are associated with post-injury depression.…”

Surgical Treatment of Burn Scars

“…This helps to achieve similar lengthening but avoiding donor site morbidity with larger flaps. While larger flaps are used for axillary contractures, smaller flaps are used for palms and digits [26]. In web space contractures, modifications of plasties and a variety of local flaps are commonly devised [27,28].…”

Effects of Virtual Reality-Based Rehabilitation on Burned Hands: A Prospective, Randomized, Single-Blind Study

“…Burned hands are usually treated and managed by a multidisciplinary team at a burn center to conservatively manage hypertrophic scars and soft tissue contractures. Rehabilitation of the burned hand should be initiated in the acute stages by means of individualized positioning, splinting, and exercise for improving functional activity [6,7]. Frequent exercise throughout the day is more beneficial 2 of 11 than one session of intensive exercise [8,9].…”