What is the proper treatment for a hand burn?

Treatment of Hand Burns

All hand burns should be immediately cooled with clean running water for 5-20 minutes, followed by appropriate wound care based on burn depth, with referral to a specialized burn center for partial or full-thickness hand burns to prevent disability.

Initial Assessment and Management

• Hand burns require immediate cooling with clean running water to limit tissue damage and reduce pain 1
• Cool the burn for 5-20 minutes, which has been shown to decrease the need for subsequent care 1
• Remove all jewelry before swelling occurs to prevent vascular compromise 1
• Administer over-the-counter pain medications such as acetaminophen or NSAIDs 1

Burn Classification and Referral Criteria

• Hand burns are classified as:

  • Superficial (first-degree): involves only epidermis
  • Partial-thickness (second-degree): involves epidermis and part of dermis
  • Full-thickness (third-degree): involves entire epidermis and dermis 1

• All partial or full-thickness hand burns require evaluation at a specialized burn center due to:

  • High risk of functional disability
  • Potential need for surgical intervention
  • Specialized rehabilitation requirements 1

Treatment Based on Burn Depth

For Superficial Burns (First-Degree)

• Continue cooling with clean running water 1
• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera 1
• Cover with a clean, non-adherent dressing 1
• Monitor for signs of infection 1

For Partial-Thickness Burns (Second-Degree)

• After cooling, loosely cover with a clean, non-adherent dressing 1
• Refer to a burn specialist or burn center immediately 1
• If transfer to a burn center will be delayed:
  • Clean the wound with tap water or isotonic saline 1
  • Apply silver sulfadiazine cream to a thickness of approximately 1/16 inch once to twice daily 2
  • Avoid tight circumferential dressings that could compromise circulation 1

For Full-Thickness Burns (Third-Degree)

• After cooling, cover with a clean, dry, non-adherent dressing 1
• Immediate referral to a burn center is mandatory 1
• Monitor for signs of compartment syndrome requiring escharotomy 1

Special Considerations for Hand Burns

• The hand represents 3% of total body surface area but is involved in up to 90% of major burns 3, 4
• Functional outcomes depend on:
  • Rapid wound closure
  • Prevention of infection
  • Preservation of motion 5
• Early mobilization and hand therapy are essential to prevent contractures 6
• Position the hand in the "anti-deformity position" (wrist extension, MCP flexion, IP extension) when at rest 7, 6

Common Pitfalls to Avoid

• Do not use ice directly on burns as it may cause further tissue damage; always wrap ice in cloth if clean running water is not available 1
• Do not apply butter, oil, or home remedies to burns 1
• Do not delay referral for partial or full-thickness hand burns, as this can lead to permanent functional impairment 1
• Do not use tight circumferential dressings that could compromise circulation 1, 5
• Do not routinely administer prophylactic antibiotics 1
• Monitor children closely for hypothermia during cooling of burns 1

Follow-up Care

• For superficial burns, continue wound care at home with daily dressing changes 1, 8
• For partial and full-thickness burns, follow burn specialist recommendations for surgical intervention and rehabilitation 3, 6
• Early and consistent hand therapy is crucial for optimal functional outcomes 7, 5