What is the best management for hand burns?

Best Management for Hand Burns

The best management for hand burns includes immediate cooling with cold tap water (15-25°C) for at least 15 minutes, wound assessment, appropriate dressing with silver sulfadiazine cream applied to a thickness of 1/16 inch, and early initiation of range of motion exercises to prevent contractures. 1

Initial Assessment and Treatment

1. Immediate cooling:

   • Cool burns with cold (15-25°C) tap water until pain is relieved
   • Do NOT apply ice directly to burns as this can worsen tissue damage 1
   • Continue cooling for at least 15 minutes for chemical burns

2. Remove potential sources of continued injury:

   • Remove any contaminated clothing, jewelry, or material from affected areas 1
   • This prevents further chemical injury and allows proper assessment

3. Wound assessment:

   • Determine burn depth and extent
   • Hand burns require special attention as they represent only 3% of total body surface area but are involved in up to 80% of all burns 2
   • Assess for neurovascular compromise with thorough examination

Wound Care

1. Topical antimicrobial therapy:

   • Apply silver sulfadiazine cream 1% to a thickness of approximately 1/16 inch once to twice daily 1, 3
   • Cover all burn areas and reapply whenever removed by patient activity 3
   • Alternative: For deeper or more complex burns, mafenide acetate 5% solution may be used, especially in grafted areas 4

2. Dressing management:

   • Dressings are optional with silver sulfadiazine but may be used based on individual requirements 3
   • Leave burn blisters intact to improve healing and reduce pain 1
   • Cover burns with sterile, non-adherent dressings applied loosely 1

3. Surgical intervention considerations:

   • Perform escharotomies when perfusion is compromised in full-thickness or circumferential burns 2
   • Consider early excision and grafting if wounds are unlikely to heal within 2-3 weeks 2
   • Decision for surgical management should be made early to optimize functional outcomes 5

Pain Management

1. Multimodal approach:
   • First-line: Acetaminophen 1g every 4-6 hours 1
   • Second-line: Add NSAIDs for inflammatory pain 1
   • For severe pain: Short-acting opioids and ketamine may be most effective 1
   • Consider non-pharmacological techniques such as virtual reality or hypnosis to reduce pain intensity and anxiety 1

Rehabilitation and Follow-up

1. Early mobilization:

   • Begin early range of motion exercises to prevent contractures 1
   • Regular stretching exercises to improve flexibility 1
   • Consider massage therapy to soften scar tissue and improve circulation 1

2. Monitoring:

   • Regular wound assessment for signs of healing or complications 1
   • Monitor for signs of compartment syndrome (5 P's: pain, pallor, paresthesia, pulselessness, paralysis) 1
   • Continue treatment with silver sulfadiazine until satisfactory healing or until the burn site is ready for grafting 3

3. Interdisciplinary approach:

   • Involve physical and occupational therapists early 6
   • Consider pressure garments for scar management once wounds have healed 5

Special Considerations

• Functional outcome: Hand burns require special attention due to their functional importance, appearance, and economic aspects 5
• Depth assessment: The distinction between second and third-degree burns is critical and may require experienced evaluation 7
• Nutritional support: Should be started within 12 hours after extensive burn injury 1

Common Pitfalls to Avoid

• Delaying escharotomy when needed, which can lead to permanent functional loss
• Using ice directly on burns, which can worsen tissue damage
• Neglecting early mobilization and rehabilitation
• Discontinuing antimicrobial treatment prematurely while infection risk remains 3
• Failing to recognize the need for surgical intervention in deep burns