Amputation Following Hand Escharotomy in Patients with Burn Injury.

Burns of the hand are a common occurrence. It is estimated that hands are involved in more than 80% of all severe burns.1 A study conducted by the US Army Institute of Surgical Research found that 88.6% of 568 patients with burn injury accrued in a 2-year period had burns of the upper extremity.2 This high rate is often attributed to a protective reflex where patients shield their faces with their hands. Burn and scald injuries lead the way in workplace injuries that result in missing an average of 5 days per year per burn from work.3 Burns of the hand can have disastrous outcomes if aggressive intervention is not initiated early. Even small burns to the hand can result in disfigurement and loss of function. Hand burns are more difficult to conceal than those to the extremities and trunk. Loss of the ability to perform activities of daily living is life altering, and preservation of activities of daily living has a large impact. Sheridan and associates4 stratified 1047 patients who had acutely burned hands. They demonstrated that 90% of patients had their activities of daily living restored with proper management of burns to the extensor mechanism, joint capsule, or bone. Good outcomes depend on the care rendered during initial burn management. We feel that recognizing the need for escharotomy is the most overlooked. Prior studies have shown that 21% of digits develop necrosis and require amputation without escharotomy in hand burn injuries.2 With prompt intervention, 97% of patients with superficial injuries and 81% with deep dermal injuries can have normal hand function.4