Hand Injuries

Burns

  • Standard burns treatment (respiratory, manage infection, rehydrate, pain relief)
  • Hand specific burns treatment
    • Excise damaged skin and perform split skin grafts early
    • Aggressive mobilisation to prevent finger stiffness
    • Escharotomy - surgical release of eschar (thick, leathery, inelastic skin which can form after burns)

Severe mutilating injuries

  • Usually industrial
  • Degloving, partial/complete amputation

Initial treatment

  • Preserve amputated parts in a moist gauze and then in ice
  • Early debridement
  • Establish stable bony support
  • Establish vascularity
  • Repair all tissues
  • Establish skin cover - grafts, flaps
  • Prevent/treat infection
  • Aggressive mobilisation

Further management

  • Early involvement with Plastics
  • Will require microsurgery to repair nerves and vessels
  • Split skin grafts onto healthy tissue
  • Flaps to cover exposed bone
  • Formal amputation if unreconstructable or unable to re-establish nerve supply
  • In amputation, consider later use of prosthetics