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Burn Injury to the Hands

by Aubrey Bailey

Burn injuries may significantly damage the skin and underlying tissues. Hand burns can be caused by dry or wet heat, electricity, radiation, lasers or chemicals. These injuries can lead to long-term disability and hand deformity. Proper management must begin immediately after the injury to optimize your recovery, including restoring hand function.

Classification

Burn wounds are typically classified as first, second or third degree, based on the depth of damage. First-degree burns damage the top layer of the skin, the epidermis. There are 2 types of second-degree burns, superficial and deep. Superficial second-degree, also called superficial partial-thickness burns, extend through the epidermis into the next skin layer, called the dermis. Deep second-degree burns extend further into the dermis. Third-degree burns extend completely through the dermis. These injuries are also known as also known as full-thickness burns because they involve all layers of the skin.

Treatment

A burned hand is first cleansed with cool water and gentle soap or saline-soaked gauze. Dead, leathery burned tissue, called eschar, can form on the hand and fingers, causing pressure to build underneath the skin, potentially reducing blood flow to the hand. This tissue must be surgically removed or cut to allow unrestricted blood flow. Topical antibiotic cream is applied and the burn is covered with sterile gauze. Dressings are typically changed twice each day until the wound has healed. Extensive burn injuries to the hand may require skin grafting to cover the wound. A small piece of the superficial skin layer is removed from another part of the body -- often the wrist, front of the elbow or the lower abdomen -- and surgically attached to the hand.

Positioning

After a burn injury, the hand automatically tries to rest in a comfortable position. Typically, the thumb is tucked in next to the hand and the wrist is bent downward. The large knuckles at the base of the fingers are commonly bent backward and the middle finger joints forward, giving the fingers a clawlike appearance. If the hand is allowed to remain in this position, the joints will become tight as scar tissue forms. Left untreated, this leads to permanent deformity and limited use of the affected hand. Splinting positions the hand in a gently stretched position to help healing without joint deformity. Custom splints are molded out of low-temperature thermoplastic material. The wrist is bent backward to approximately 30 degrees and the large knuckles of the hand are bent forward to 70 degrees. The fingers are splinted in a straight position and the thumb is positioned out to the side, away from the hand. The splint is worn all the time, except for wound care and exercise. Splint use may continue for several weeks or months, depending on the severity of the burn injury.

Rehabilitation

Rehabilitation is an integral part of managing burn injuries to the hand. Occupational and physical therapists prescribe range-of-motion exercises to improve mobility and decrease joint stiffness in the hand while a burn wound is healing. This typically begins while the person is in the hospital and continues as the wound heals. Once the wound is closed, scar management techniques, such as massage and compression gloves, help flatten the scar and decrease scar sensitivity. Therapists also perform manual stretching to increase joint mobility in the fingers. Strengthening exercises for the hand and fingers help improve grip strength, fine motor control and function with daily tasks.

About the Author

Aubrey Bailey has been writing health-related articles since 2009. Her articles have appeared in ADVANCE for Physical Therapy & Rehab Medicine. She holds a Bachelor of Science in physical therapy and Bachelor of Arts in psychology from the University at Buffalo, as well as a post-professional Doctor of Physical Therapy from Utica College. Dr. Bailey is also a certified hand therapist.

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