How to manage full thickness friction burns on the hand?

Management of Full Thickness Friction Burns on the Hand

Full thickness friction burns on the hand require immediate medical evaluation and specialized care, with treatment typically involving surgical debridement and skin grafting to optimize functional outcomes and prevent complications. 1

Initial Assessment and First Aid

• Immediate cooling: Apply cool or cold potable water (15-25°C) for at least 10 minutes to limit burn progression 1

• Avoid harmful practices:

  • Do not use ice or ice water directly on the burn (can cause tissue ischemia)
  • Do not apply butter, oil, or home remedies
  • Do not break blisters intentionally 1

• Pain management: Implement multimodal analgesia with acetaminophen or NSAIDs; consider stronger analgesics for severe pain 1

Clinical Assessment

• Determine burn depth: Full thickness burns involve all skin layers and may expose underlying structures 1
• Assess severity: Hand burns are considered severe regardless of size due to functional importance 1
• Evaluate for complications: Check distal circulation, sensation, and motor function every 15-30 minutes to monitor for compartment syndrome 1

Management Based on Severity

Grade III-IV Friction Burns (Full Thickness with Tendon/Bone Exposure)

• Surgical intervention is required for full thickness friction burns on the hand 2, 3

• Treatment protocol:

  1. Early surgical debridement to remove devitalized tissue
  2. Vacuum sealing drainage may be used initially
  3. Split-thickness or full-thickness skin grafting 4, 3

• Surgical approach: Multiple operations (average 2.4) are often needed, with most patients requiring skin grafting 3

Special Considerations for Hand Burns

• Functional preservation: Hand burns require specialized care due to functional importance
• Flap selection: For deep friction burns with tendon/bone exposure, free muscle flaps may provide better functional outcomes than reverse-pedicled forearm flaps, though aesthetic results may be inferior 2
• Early intervention: Early debridement and grafting for deep friction burns can reduce pediatric pain, shorten recovery time, and restore hand function more quickly 4

Wound Care

• Dressing: Cover with sterile, non-adherent dressing applied loosely 1
• Antimicrobial agents: Apply topical antimicrobial agents only to sloughy areas, not intact tissue 1
• Monitoring: Watch for signs of infection (increased redness, warmth, swelling, discharge, or fever) 1

Follow-up Care

• Specialized referral: Refer to a burn center for comprehensive management 1
• Rehabilitation: Early mobilization and physical therapy are crucial for preserving hand function
• Scar management: Early intervention produces better scar outcomes compared to delayed repair (Vancouver Scar Scale score 4.15 vs 7.22) 4

Common Pitfalls to Avoid

• Delayed referral: Hand burns should be evaluated promptly by specialists due to functional importance
• Inadequate debridement: Friction burns are often deeper than they appear and require thorough assessment
• Underestimating severity: Patients with friction burns from high-energy trauma often have concomitant injuries requiring comprehensive evaluation 3
• Inappropriate dressing selection: Despite many available options, evidence supports specialized burn dressings rather than traditional options like silver sulfadiazine cream 5