Management of Hand Burns
All partial-thickness and full-thickness hand burns require immediate referral to a specialized burn center, as these injuries demand expert surgical intervention to prevent 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 the need for subsequent medical care. 1, 2 This is the single most important initial intervention supported by meta-analysis of over 11,000 patients. 1
- Monitor children closely during cooling for signs of hypothermia, particularly with larger burns involving the hands. 1
- If clean running water is unavailable, ice wrapped in cloth may be used for superficial burns with intact skin only—never apply ice directly. 1
Remove all jewelry and rings immediately before swelling develops to prevent vascular compromise and tissue ischemia. 1, 2
Pain Control
Administer over-the-counter analgesics such as acetaminophen or NSAIDs (ibuprofen) for pain management. 1, 2 These medications are well-tolerated and effective for burn pain. 1
Wound Coverage During Transfer
After cooling, loosely cover the burn with a clean, non-adherent dressing while arranging immediate specialist evaluation. 1, 2
- For small superficial partial-thickness burns being managed temporarily at home, apply petrolatum-based antibiotic ointment (such as polymyxin), honey, or aloe vera after cooling, then cover with a non-adherent dressing. 1, 2
- If transfer is delayed, clean the wound with tap water or isotonic saline before dressing. 2, 3
Mandatory Specialist Referral
All hand burns involving partial-thickness (second-degree) or full-thickness (third-degree) depth require immediate burn center evaluation, regardless of total body surface area. 1, 2 The American Burn Association specifically mandates this because:
- Hand burns may require surgical intervention including early excision and grafting to prevent permanent disability. 1, 2
- Specialized burn centers improve survival rates and functional outcomes through concentrated expertise. 1, 2
- Direct admission to a burn center (rather than sequential transfers) reduces morbidity and mortality. 1, 2
Use telemedicine consultation if immediate specialist access is unavailable to guide initial management and determine transfer urgency. 1, 2
Monitoring for Complications
Watch for signs of compartment syndrome requiring emergency escharotomy:
- Blue, purple, or pale fingers indicating poor perfusion. 1, 2
- Progressive swelling causing vascular compromise. 1
- Ideally, escharotomy should be performed in a burn center by an experienced provider. 1
Monitor for infection including increased pain, redness extending beyond burn margins, swelling, or purulent discharge. 2, 3
Critical Pitfalls to Avoid
- Do not delay specialist referral for any partial-thickness or full-thickness hand burn—undertriage increases morbidity and mortality. 1, 2
- Do not apply butter, oil, or home remedies to burns. 2, 4
- Do not break blisters—this significantly increases infection risk. 4, 3
- Do not use prophylactic systemic antibiotics—reserve for clinically evident infections only. 1, 2, 3
- Avoid prolonged silver sulfadiazine use on superficial burns as it may delay healing. 4, 3, 5
- Do not apply ice directly to burn wounds as this causes additional tissue damage. 2, 4, 3
Definitive Treatment at Burn Center
Once at a specialized facility, treatment typically includes:
- Early surgical excision of necrotic tissue and skin grafting to reduce infection risk and improve outcomes. 1
- Aggressive range-of-motion therapy to prevent contractures—even one week of neglect can lead to severe digital malpositioning. 6, 7
- Specialized wound dressings and antimicrobial therapy as needed. 1, 3
The functional importance of the hand cannot be overemphasized, as the patient's ability to perform useful work and self-care is largely determined by residual hand function. 8, 7