Hand Burns and burns contractures
Burns to the hand can range from severity from mild (superficial partial thickness) to severe (deep partial thickness or full thickness). The most common cause of hand burns is contact with a flame, hot liquids or hot surfaces. Other causes include friction burns due to contact with a treadmill belt or other rapidly spinning object, chemical burns due to contact with corrosive chemicals such as acids or alkalis, and electrical burns. The severity of the burn depends on the duration of contact and temperature for heat burns, the duration of contact and nature of the chemical for chemical burns, and the amount of energy in an electrical burn.
Emergency care of burns
For heat or friction burns, immediately remove the source of heat and put the hand under running cool water for about 10 minutes. DO NOT use ice packs or ice water as this will cause more damage. Wrap in a moist cool towel and see a hand specialist immediately.
For chemical burns, immediately wash the contaminated area with running water for about 10 minutes if it is an acid. If it is a strong alkali, DO NOT use water as this can increase the damage. There are usually instructions on the bottle or container on what to do, and these must be followed precisely. See a hand specialist immediately.
For electrical burns, turn off the power immediately. Depending on the power source and energy transferred, these can be life-threatening. Call an ambulance or go directly to the emergency department of a major hospital.
If possible, remove ALL rings and bracelets immediately from the burned hand, as the hand will soon swell up, making it impossible to remove them. These can then become so tight that the blood circulation to the fingers is cut off.
Simple or superficial burns
Only the most superficial part of the skin is injured. This is similar to a bad sunburn. The skin turns red, and there may be blistering or peeling of the skin. They are usually very painful or tender to touch. Simple or superficial burns will heal by themselves over 1-2 weeks with dressings. The blisters should not be burst or peeled off as the fluid encourages skin healing. If they are large and uncomfortable, some of the fluid can be sucked out with a sterile syringe to flatten them. Dressings should be used until the skin has healed to prevent any infection. There are usually no scars, but the skin colour may become lighter or darker.
Deep partial thickness burns and full thickness burns
If the skin is pale or feels thick and leathery with little pain and little sensation, then the burn is deep. If it is black and hard, then it is a full thickness burn. When the deeper part of the skin or the entire thickness of the skin is injured, healing will be very slow and result in severe scarring. There is a high risk of infection, which will increase the damage and scarring. These burns need to be operated on as soon as possible. The dead layers of skin must be cut away until there is healthy skin. A piece of skin from another part of the body (skin graft) is used to cover the wound. This will heal quickly over 2 weeks with less scarring.
Occasionally, the burn is so deep that tissues beneath the skin such as bone, joint, tendon and nerves are also injured. This usually happens with electrical burns or when there has been prolonged contact with heat or corrosive chemicals. The other damaged tissues may need to be reconstructed. A piece of tissue including skin and fat (flap) will need to be taken from another part of the body to close the wound. In very severe cases, the burned part is too badly damaged and may need to be amputated.
Rehabilitation after hand burns
A supervised rehabilitation programme is essential after severe hand burns. This includes exercises to keep the joints moving, a splint to use between exercises, and silicon sheets to minimize scarring. Generally, 3-6 months of therapy are needed, as this is the time over which scar forms and matures. The goal of therapy is to minimize scar contractures across joints that may severely restrict hand function.
Contractures can form after severe burns to the hand. These are the result of excessive scarring across joints. Scar tissue is hard and limits the movement of the joint it crosses. In severe cases, the joint can become frozen in a position that prevents the finger from functioning. The stiff fingers may also get in the way of the uninjured fingers, compromising the function of the entire hand. Over time, the bone and cartilage of the contracted joints becomes damaged and it will no longer be possible to move the joint properly even if the scar is removed.
Treatment of burns contractures requires surgery to cut away the scar tissue and release the stiff joints. Skin grafts or flaps may also be needed to close the wounds made by cutting away the scar. If the joints are already badly damaged, they may need to be fused in a position that allows better function. Following surgery, 3-6 months of therapy are needed, including splinting, exercises, and scar therapy.
Index finger burns contracture treated with skin graft