When should a hand burn be referred to a specialized burn center or hand‑surgery service?

Hand Burn Referral Criteria

All hand burns involving partial-thickness or full-thickness depth require immediate referral to a burn specialist or burn center, regardless of total body surface area, because specialized care is mandatory to prevent permanent functional disability. 1

Immediate Referral Indications

Mandatory Specialist Consultation

• Any deep burn involving the hand (partial-thickness or full-thickness) requires immediate burn center referral, as hand burns are function-sensitive injuries that demand specialized surgical techniques and therapy beyond first aid capabilities 1, 2
• Contact a burn specialist immediately—do not delay this consultation even for seemingly small hand burns, as undertriage increases morbidity and leads to permanent functional impairment 1, 2
• Use telemedicine consultation if immediate specialist access is unavailable to guide initial management and determine transfer urgency 1, 2

Specific High-Risk Features Requiring Referral

• Blanched skin falling off the fingers indicates deep partial-thickness or full-thickness burns requiring immediate specialist referral 1
• Circumferential burns of the hand or fingers necessitate burn center transfer due to compartment syndrome risk 2
• Any hand burn with signs of compartment syndrome (blue, purple, or pale extremities indicating poor perfusion) requires emergency escharotomy and immediate transfer 1, 2
• Electrical or chemical burns involving the hand require burn center referral regardless of apparent surface area 2

Pediatric-Specific Criteria

• Any hand burn in infants <1 year of age requires burn center referral 1
• Pediatric patients with hand burns and severe comorbidities require specialist consultation 1
• Deep burns in function-sensitive areas including hands in children mandate burn center transfer regardless of size 2

Pre-Transfer Management

Initial Stabilization

• Cool the burn immediately with clean running water for 5-20 minutes to limit tissue damage, monitoring children closely for hypothermia 1
• Remove jewelry before swelling onset to prevent vascular ischemia 2
• Loosely cover with clean, non-adherent dressing while arranging immediate transfer 1

Pain Control During Transfer

• Administer titrated intravenous opioids or ketamine for severe burn pain 2
• Over-the-counter analgesics (acetaminophen or NSAIDs) are appropriate only for superficial burns 1

Why Specialist Care Is Non-Negotiable

• Specialized burn centers improve survival rates and functional outcomes through concentrated expertise in burn care techniques 1
• Direct admission to a burn center (rather than sequential transfers) improves survival and functional prognosis 1, 2
• Specialist care prevents permanent functional disability through specialized surgical techniques, multidisciplinary rehabilitation, and experienced hand therapy 1
• Hands are involved in over 90% of severe burns, and despite negligible mortality in isolated hand burns, morbidity can be substantial given the functional importance of hands in activities of daily living 3

Critical Pitfalls to Avoid

• Never delay referral for any partial-thickness or full-thickness hand burn—this is the single most important decision point, as delay leads to permanent functional impairment 1, 2
• Do not attempt definitive management of deep hand burns in non-specialized settings, as determining burn depth requires experience and specialized care is essential for good functional outcomes 4, 5
• Do not break blisters, as this increases infection risk 1
• Do not apply butter, oil, or other home remedies 1
• Do not delay escharotomy when compartment syndrome is evident 2