What is the treatment for a large burn of the hand?

Treatment for Large Hand Burns

Large hand burns require immediate cooling with clean running water for 5-20 minutes, followed by urgent referral to a specialized burn center, as all partial-thickness and full-thickness hand burns mandate specialist evaluation due to the high risk of permanent functional disability. 1, 2

Immediate First Aid Management

• Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage and reduce pain, which decreases the need for subsequent care 1, 2, 3
• Remove all jewelry and constrictive items before swelling occurs to prevent vascular compromise and ischemia 2, 3
• Monitor children closely for signs of hypothermia during active cooling, particularly with larger burns 1, 2
• If clean running water is unavailable, cooling superficial burns with ice wrapped in cloth may be reasonable, but never apply ice directly to the burn 1, 3

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for pain control 1, 2, 3

Wound Coverage and Dressing

• After cooling, loosely cover the burn with a clean, non-adherent dressing while arranging immediate transfer 2, 4
• For superficial burns being managed at home (which should be rare for large hand burns), apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera after cooling 1, 2
• Clean the wound with tap water or isotonic saline if transfer to a burn center is delayed 2, 4

Mandatory Referral Criteria

All large hand burns require immediate referral to a burn specialist or burn center because:

• Hand burns involving partial-thickness (second-degree) or full-thickness (third-degree) depth require specialized care beyond first aid to prevent functional disability 1, 2, 5
• The hand is involved in close to 80-90% of all burns and represents critical functional anatomy 5, 6
• Specialist management improves survival and functional prognosis through multidisciplinary care 1
• Telemedicine consultation should be used if immediate specialist access is unavailable to guide initial management and determine transfer urgency 1

Monitoring for Complications

• Watch for signs of compartment syndrome including blue, purple, or pale extremities, which indicate poor perfusion and require emergency escharotomy 1, 2
• Escharotomy should ideally be performed in a burn center by an experienced provider when deep burns cause compartment syndrome compromising circulation 1, 7
• Monitor for signs of infection including increased pain, redness extending beyond burn margins, swelling, or purulent discharge 4

Specialized Burn Center Management

Once at a burn center, treatment includes:

• Wound cleansing and debridement under sterile conditions 8
• Application of topical antimicrobials such as silver sulfadiazine 1% cream applied once to twice daily to a thickness of approximately one-sixteenth inch, continued until satisfactory healing or readiness for grafting 8
• Mafenide acetate 5% solution for grafted areas, with dressings kept wet through irrigation every 4-8 hours for up to 5 days 9
• Early excision and grafting for deep burns that will not heal within 2-3 weeks 2, 6
• Splinting in the antideformity position to prevent contractures 10
• Early mobilization and occupational therapy as soon as tolerated 10, 7

Critical Pitfalls to Avoid

• Do not delay referral for any partial-thickness or full-thickness hand burn, as this leads to permanent functional impairment 2
• Do not apply butter, oil, or other home remedies to burns 2, 3
• Do not break blisters, as this increases infection risk 3
• Do not use systemic antibiotics prophylactically; reserve for clinically evident infections 4
• Avoid prolonged use of silver sulfadiazine on superficial burns as it may delay healing 4
• Do not perform incomplete escharotomies when indicated, as this can still result in amputation despite intervention 7