What is the proper dressing for a friction burn to the back of the hand?

Proper Dressing for Friction Burns to the Back of the Hand

For a friction burn to the back of the hand, the proper dressing consists of a sterile non-adherent dressing applied loosely after cleaning the wound and applying a thin layer of antibiotic ointment (if no known allergies). 1

Initial Assessment and Treatment

1. Cool the injury first:

   • Run room temperature water (15-25°C) over the burn for at least 10 minutes 1
   • This helps reduce pain and prevent further tissue damage

2. Assess burn depth and severity:

   • Friction burns on the hand typically present as partial-thickness (second-degree) burns
   • Check for:
     • Intact blisters (indicates second-degree burn)
     • Exposed tendons or bone (indicates deeper injury requiring immediate medical attention) 1, 2
   • The hand represents approximately 2.5-3% of total body surface area (TBSA) 3

Wound Preparation and Dressing Application

1. Clean the wound:

   • Gently clean with mild soap and water
   • Do not scrub aggressively as this may damage viable tissue

2. Blister management:

   • Leave blisters intact to improve healing and reduce pain 1
   • Protect intact blisters with the dressing to prevent accidental rupture

3. Apply appropriate topical agent:

   • For partial-thickness burns: Apply a thin layer of antibiotic ointment if no known allergies 1
   • For deeper burns: Apply a thin layer (1/16 inch) of 1% silver sulfadiazine cream 1

4. Apply proper dressing:

   • Cover with a sterile, non-adherent dressing applied loosely 1
   • Hydrocolloid dressings may be beneficial for partial-thickness burns as they promote moist wound healing, provide pain relief, and can improve cosmetic outcomes 4

Follow-up Care and Monitoring

• Change dressing regularly (typically every 24-48 hours) to assess healing
• Monitor for signs of infection (increased pain, redness, swelling, purulent discharge)
• Initiate early range-of-motion exercises to prevent stiffness 5
• Seek immediate medical attention if:
  • The burn appears to be full-thickness (third-degree)
  • There is exposure of tendons, bones, or joints 2
  • Signs of infection develop
  • The burn covers a large area of the hand

Special Considerations for Hand Burns

• Hand burns require special attention due to their functional importance 3
• Even seemingly minor friction burns may require close monitoring, as some patients (particularly those with high injury severity scores) may ultimately need surgical intervention 6
• Early mobilization and physical therapy are crucial to prevent contractures and maintain function 5, 3

Common Pitfalls to Avoid

• Applying dressings too tightly, which can restrict circulation and cause further damage
• Using adhesive dressings directly on the burn, which can cause further injury when removed
• Delaying treatment for deep burns involving tendons or joints
• Neglecting pain management, which can impede healing and rehabilitation
• Failing to initiate early range-of-motion exercises, leading to stiffness and loss of function