Early Tangential Excision and Immediate Mesh Autografting of Deep Dermal Hand Burns

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Abstract
Thermal injuries to the hand constitute not only one of the most common burns, but one of the most difficult for the burn surgeon to treat. Early wound closure is mandatory if maximum functional return is to be attained and scarring minimized. Over the last 3 1/2 yr, 60 patients with deep dermal dorsal hand and finger burns were treated by tangential excision and immediate mesh autografting. All patients were admitted to the hospital within 24 h of injury and excision was performed between the 3rd-10th post-burn day. Operative technique consisted of sequential eschar excision using the Humby knife or Goulian-Weck dermatome until viable dermis was visible. Mesh autograft, ratio 1-1 1/2 without expansion, was applied. There was 100% graft take in all but 4 hands. Hand function, with full range of motion returned by the 10th postoperative day. Complications were minor. Patient follow-up ranged from 6 mo.-3 1/2 yr. No patient has required subsequent surgery for scar revision or contracture release. Range of motion in all patients has been excellent; all patients have continued to maintain normal hand function. The cosmetic appearance has been good except for the early mesh appearance of the graft which has become less apparent with time. Early tangential excision and immediate mesh autografting of deep dermal dorsal hand burns has fulfilled the following burn principles.sbd.tissue preservation, prevention of wound infection, maintenance of function and early wound closure.