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Burns of the hand are prevalent and must be managed aggressively in the acute phase to prevent deformity and disability. Proper early wound management, achieving durable soft tissue coverage, and appropriate positioning in the acute period offer substantial benefits to patients long-term. When contractures occur, secondary procedures are often indicated, and they range from laser therapy to local/regional flap coverage; rarely free flaps are used. Boutonniere deformities are common, and unfortunately, at times finger amputation renders the hand more functional than further efforts at reconstruction.

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Soft casts have been introduced as an efficacious strategy to manage hand burns that simplifies wound care for families. We hypothesized that the outpatient use of soft casts in pediatric hand burns would be viewed as acceptable by patient caregivers and providers, logistically feasible, and result in satisfactory clinical outcomes. A review was performed of pediatric clinic patients managed with soft casts since implementation (9/2022 - 9/2023). Patient caregivers and providers were surveyed. The primary outcome was acceptability of soft casts as a management strategy (questions targeted care burden, overall satisfaction, comfort, pragmatism, and healing concerns). Secondary outcome was feasibility (effect on clinic workflow, efficiency). Survey responses were collected from 70% of caregivers and 95% of providers. Responses overwhelmingly favored soft cast acceptability. Among providers, 84% agreed that "the soft cast method simplified the hand burn care experience in our clinic" and 100% indicated "the soft cast was easy for parents to manage at home" (Likert range 7-10, mode 10). Thirty-three English-speaking patients with partial and full thickness hand burns were managed with soft casts. A mean of 1.8 reapplications (mode 1, range 1-5) were required with median healing time of 13 days. No infections were attributed to the use of soft casting, and only one patient ultimately required grafting. Overall, the introduction of soft casts as a management strategy for pediatric hand burns was acceptable and feasible. The clinical outcomes assessed suggest soft casts are associated with good wound healing with minimal wound care responsibilities for patient and family.

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Preservation and restoration of hand function after burn injuries are challenging yet imperative. This study aimed to assess the curative effect of a composite skin graft over an acellular dermal matrix (ADM) and a thick split-thickness skin graft (STSG) for treating deep burns on the hand. Patients who met the inclusion criteria at the First Affiliated Hospital of Wenzhou Medical University between September 2011 and January 2020 were retrospectively identified from the operative register. We investigated patient characteristics, time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery, donor site recovery, complications and days to complete healing. Patients were followed up for 12 months to evaluate scar quality using the Vancouver Scar Scale (VSS) and hand function through total active motion (TAM) and the Jebsen-Taylor Hand Function Test (JTHFT). A total of 38 patients (52 hands) who received thin STSG on top of the ADM or thick STSG were included. The location of the donor sites was significantly different between Group A (thick STSG) and Group B (thin STSG + ADM) (p = 0.03). There were no statistical differences in age, gender, underlying disease, cause of burn, burn area, dominant hand, patients with two hands operated on and time from burn to surgery between the two groups (p > 0.05). The time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery and days to complete healing were not significantly different between Group A and Group B (p > 0.05). The rate of donor sites requiring skin grafting was lower in Group B than in Group A (22.2% vs. 100%, p < 0.001). There were no statistically significant differences in complications between the groups (p = 0.12). Moreover, 12 months postoperatively, the pliability subscore in the VSS was significantly lower in Group A than in Group B (p = 0.01). However, there were no statistically significant differences in vascularity (p = 0.42), pigmentation (p = 0.31) and height subscores (p = 0.13). The TAM and JTHFT results revealed no statistically significant differences between the two groups (p = 0.22 and 0.06, respectively). The ADM combined with thin STSG is a valuable approach for treating deep and extensive hand burns with low donor site morbidity. It has a good appearance and function in patients with hand burns, especially in patients with limited donor sites.

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Background and Objectives: Burn surgery on the hands is a difficult procedure due to the complex anatomy and fragility of the area. Enzymatic debridement has been shown to effectively remove burn eschar while minimizing damage to the surrounding tissue and has therefore become a standard procedure in many burn centers worldwide over the past decade. However, surprisingly, our recent literature review showed limited valid data on the long-term scarring after the enzymatic debridement of the hands. Therefore, we decided to present our study on this topic to fill this gap. Materials and Methods: This study analyzed partial-thickness to deep dermal burns on the hands that had undergone enzymatic debridement at least 12 months prior. Objective measures, like flexibility, trans-epidermal water loss, erythema, pigmentation, and microcirculation, were recorded and compared intraindividually to the uninjured skin in the same area of the other hand to assess the regenerative potential of the skin after EDNX. The subjective scar quality was evaluated using the patient and observer scar assessment scale (POSAS), the Vancouver Scar Scale (VSS), and the "Disabilities of the Arm, Shoulder, and Hand" (DASH) questionnaire and compared interindividually to a control group of 15 patients who had received traditional surgical debridement for hand burns of the same depth. Results: Between January 2014 and December 2015, 31 hand burns in 28 male and 3 female patients were treated with enzymatic debridement. After 12 months, the treated wounds showed no significant differences compared to the untreated skin in terms of flexibility, trans-epidermal water loss, pigmentation, and skin surface. However, the treated wounds still exhibited significantly increased blood circulation and erythema compared to the untreated areas. In comparison to the control group who received traditional surgical debridement, scarring was rated as significantly superior. Conclusions: In summary, it can be concluded that the objective skin quality following enzymatic debridement is comparable to that of healthy skin after 12 months and subjectively fares better than that after tangential excision. This confirms the superiority of enzymatic debridement in the treatment of deep dermal burns of the hand and solidifies its position as the gold standard.

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INTRODUCTION: A new outcome measure for hand burn injuries was co-designed within a Participatory Action Research framework with expert clinicians and individuals with hand burn injuries. The outcome measure reviews activities which are commonly interrupted post hand burn injuries and includes 18 activities. OBJECTIVE: The aim of this study was to establish the clinical utility, face, and content validity of the newly developed outcome measure. METHODS: Three constructs of interest were examined using study specific questionnaires from the perspectives of clinicians and individuals with hand burn injuries. Clinicians working in burns centres around Australia and New Zealand and individuals attending a burn centre within one tertiary hospital trialled the outcome measure. Upon testing the outcome measure each participant completed the questionnaire. RESULTS: Twenty individuals with hand burn injuries and eight clinicians trialled the outcome measure. There was 85% agreement from individuals and 100% agreement from clinicians for face validity. Content validity was tested across the domains of relevance and clarity. Individuals rated all activities and clinicians rated 16 activities as relevant. Clarity of activities was high for both participant groups (>75% agreement). Clinical utility (measured in the domains of appropriateness, accessibility, practicability, and acceptability) was high, 95% of individuals reported agreement for practicability and 100% agreement for acceptability. Clinicians reported agreement of > 87.5% for appropriateness, accessibility, practicability, and acceptability. CONCLUSION: The results demonstrated agreement for clinical utility, face, and content validity of the co-design outcome measure for hand burn injuries. Further validity and reliability testing is planned, including Rasch analysis.

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Background: The effect of artificial highly concentrated carbon dioxide bathing on heat-press-injured wounds has been clinically observed. Case presentation: A 46-year-old male patient with a heat press injury of the right palmar region achieved complete necrotic tissue removal and sufficient granulation of the skin graft by continuous hand bathing in a solution containing highly concentrated carbon dioxide for four weeks. The patient successfully underwent a full-thickness skin graft from the plantar to the palmar region, and his right hand function improved to the extent that it did not interfere with daily life. Conclusions: Heat press injuries are often refractory to treatment owing to the synergistic effects of heat and crush injuries. Highly concentrated carbon dioxide bathing has long been known to increase skin and muscle blood flow, and its clinical applications in ischemic limbs, skin ulcers, and osteomyelitis have already been reported. In this case, the results suggest an effect of improved blood flow leading to maturation of the graft bed at the heat-press injury site. Lay Summary: Highly concentrated carbon dioxide bathing is not only clinically applicable to ischemic extremities, skin ulcers, and osteomyelitis, due to increased cutaneous and muscular blood flow, but also to the reliable debridement of heat press injury wounds and the granulation of graft beds. We successfully used this novel combination of procedures to establish a graft bed with a good blood flow despite the deep heat press injury occurring in the palmar region, leading to an excellent functional recovery. The cost per procedure is low, at about $1(USD), making it a wound care option that should be considered from a healthcare economic perspective.

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INTRODUCTION AND IMPORTANCE: Burn still the major cause of disabilities and challenge facing both patient and surgeon, and when hands were affected a comprehensive planning and work must be obtained to restore functional and aesthetic aspects of hand. Tensor fascia lata (TFL) considered since centuries a useful tool to save hand post burn either it was been harvested with pedicle or as free flap. Although pedicle TFL became seldom but it may be the best option for hand reconstruction. In this article we report a case of hand burn that was managed by pedicle TFL. CASE PRESENTATION: A 32 year- old man was involved in thermal burn affected multiple areas of his torso and limbs. He was referred to hospital from primary health care center. At hospital reassessment of the patient done was hemodynamic stable and inhalation injury was excluded. Burn estimated at 36 % total body surface area (TBSA) distributed through trunk and left upper limb, but left hand was the most affected area. CLINICAL DISSOCIATION: After stabilization, he underwent serial debridement and dorsum of hand became skeletonized with exposed bones and tendon. Pedicled tensor fascia lata eventually choose to resurface hand, and fortunately enough covered all hand. CONCLUSION: Tensor fascia late flap still has favorable use, easy applicable and expected outcome. in this article we report post burn hand injury that managed by pedicled tensor fascia lata.

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Despite improvements in treatment methods and outcomes, burns remain one of the principal causes of mortality and morbidity worldwide. Burns involving the hands are estimated to occur in >80% of people with burns. Hand burns have also been associated with long-term social, psychological and physical consequences that can impede a patient's full reintegration to the community and decrease their overall quality of life. Clinically, when the trajectory towards complete re-epithelialisation stalls in deep burn wounds of the hand, skin grafting is indicated, but cosmetic problems often remain. A recent publication highlighted common complications for burns involving the hand such as scar disturbances (26%) and scar contractures (14%). Innovative approaches with the potential to reduce the occurrence of complicating scar disturbances and contractures are sought by healthcare providers specialising in burns. This case report describes a novel approach to wound closure using a topical concentrate of proteolytic enzymes followed by the application of an autologous skin cell suspension. This combination was effective in achieving early and complete re-epithelialisation of a deep burn of the palm of a 28-year-old male patient, while potentially affording a favourable impact on hypertrophic scarring or scar contracture.

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Thermal burns remain a significant public health concern, and it is crucial to understand the potential risks associated with everyday activities involving heated objects or surfaces. It has been found that males have a higher susceptibility to hand burns, but when it comes to burns caused by hot liquids, females tend to be more frequently affected. Cooking remains the predominant activity associated with a higher incidence of accidental hand burns. Prompt medical attention and appropriate management are essential in mitigating the severity of burn injuries. This case report presents a previously healthy 55-year-old female that sustained a superficial partial-thickness burn to the dorsal aspect of her right hand while preparing a meal in her kitchen with her brand-new convection oven. This was her first time using a convection oven, unaware of the fans and rapidly circulating hot air within the oven. We discuss the need for a comprehensive approach to wound care, including topical antimicrobial agents, dressings, pain management, and monitoring for potential complications to achieve favorable outcomes and minimize long-term sequelae. Prevention remains the cornerstone in reducing burn injuries. Awareness campaigns, safety guidelines, and educational initiatives aimed at promoting responsible handling of hot objects should be implemented. Simple preventive measures, such as using appropriate protective equipment such as oven mitts, being mindful of oven temperatures, and maintaining a safe distance from heated surfaces, can significantly reduce the risk of household thermal burns.

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OBJECTIVES: The aim of this study was to evaluate the functional and cosmetic results of an innovative procedure for modified Colson flap-graft consisting of immediate defatting of the flap by a liposuction cannula. METHODS: A cross-sectional study was performed among patients with deep hand burns requiring a modified Colson flap between 2018 and 2021. Outcomes included functional and cosmetic assessment of the hand through a quality-of-life questionnaire, a sensitivity scale and a scar assessment scale. RESULTS: During this period, 7 patients were operated on using our technique. One patient was lost to follow-up; 7 patients with a median age of 44 years were included, with a total of 10 burned hands. The burns were thermal in 5 out of 7 cases and the coverage concerned the whole hand in 50% of the cases. The flaps all received cannula defatting. The median time to flap weaning was 23 days (20 to 30 days). The median follow-up was 16 months. One case required remote flap weaning. The median POSAS (Patient and Observer Scar Assessment Scale) per patient was 4 and 2 per observer. The median BMRCSS (British Medical Research Council Sensory Scale) was 122. One case had recovered S2 sensitivity, the other cases had S3 or S4 sensitivity. CONCLUSION: Immediate defatting is one of the factors in tegumental quality allowing rapid functional recovery of the hand. The cannula defatting technique does not appear to require additional defatting time. The use of the liposuction cannula allows a one-step, homogeneous, and easier defatting, with a lower risk of devascularization.

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Objective: This study aims to explore the clinical effect of early rehabilitation training combined with negative pressure wound therapy (NPWT) for treating deep partial-thickness hand burns. Methods: Twenty patients with deep partial-thickness hand burns were randomly divided into an experimental group (n = 10) and a control group (n = 10). In the experimental group, early rehabilitation training combined with NPWT was performed, including the proper sealing of the negative pressure device, intraoperative plastic brace, early postoperative exercise therapy during negative pressure treatment, and intraoperative and postoperative body positioning. Routine NPWT was conducted in the control group. Both groups received 4 weeks of rehabilitation after wounds healed by NPWT with or without skin grafts. Hand function was evaluated after wound healing and 4 weeks after rehabilitation, including hand joint total active motion (TAM) and the brief Michigan Hand Questionnaire (bMHQ). Results: Twenty patients were involved in this study, including 16 men and 4 women, aged 18-70 years, and the hand burn area ranged from 0.5% to 2% of the total body surface area (TBSA). There was no significant difference in TAM and bMHQ scores between the two groups after negative pressure removal. After 4 weeks of rehabilitation training, the TAM scores and bMHQ scores were significantly improved in both groups (p < 0.05); among them, those of the experimental group were both significantly better than those of the control group (p < 0.05). Conclusion: The application of early rehabilitation training combined with NPWT to treat deep partial-thickness hand burns can effectively improve hand function.

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BACKGROUND: Hand burn injuries are common among pediatric patients. Management of deep partial thickness and full thickness hand burns varies by center, with some favoring upfront autografting and others using dermal substrates (DS) as biologic dressings to accelerate burn wound healing. Achieving best outcomes is critical in children given the propensity of burn wound scars to affect hand function as a child grows and develops. Given potential complications associated with autografting in children, our center often prefers to treat pediatric hand burns initially with DS, with subsequent autografting if there is failure to heal. In this case series, we examined the outcomes of this practice. METHODS: We conducted a retrospective review of pediatric burn patients with <10% total body surface area (TBSA) burns who underwent application of DS to hand burn injuries between 2013 and 2021. Burn mechanism, patient demographics, wound treatment details, healing and functional outcomes, and complications were collected. Descriptive statistics were computed. RESULTS: Fifty patients with hand burns and overall <10% TBSA burns underwent application of DS to hands. Median age at the time of injury was 4.1 years (IQR: 1.8, 10.7) and 29 patients (58%) were male. Eighteen (36%) patients had bilateral hand burns, 10 (20%) had burns to their dominant hand, 6 (12%) their non-dominant hand, and 16 (32%) had unestablished or unknown hand dominance. Subsequent autografting was required in 5 (10%) patients treated initially with DS; four of these patients had full thickness injuries. Five (10%) patients developed contracture at the site of DS application for which two underwent scar release with tissue rearrangement, one underwent laser treatment, and two were managed conservatively. Most patients had splints (94%), or compression garments (54%) prescribed to aid in functional recovery. CONCLUSION: Children with hand burns who underwent DS application healed well with few requiring autografting or developing contractures. Most patients who needed autografting had deeper injuries. Most patients who developed a contracture required additional procedural intervention. Recognizing factors that contribute to the need for autografting after initial treatment with DS can help direct intervention decisions in pediatric patients with hand burn injuries.

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INTRODUCTION AND IMPORTANCE: Burn contracture has been a challenge for its acquired functional disabilities and deformities. Surgical reconstruction poses a significant challenge for optimal aesthetic and functional improvement. Super thin abdominal skin pedicle flap can be used, but it has only one pedicle from one site of abdomen and needs tissue expander for a larger defect. The use of modified glove-like abdominal flap has been stated to be an option mainly for the use on acute hand burn. In this study, application of the modified glove-like abdominal flap was applied to contracture of dorsal hand and fingers. CASE PRESENTATION: A 39-year-old male patient with severe contracted hand, eight-month post-burn injury presented at outpatient clinic Santosa Central Hospital in 2017. Multiple series of surgeries were performed on this patient, consisting of released contracture, defect closure using a modified "glove-like" thin abdominal flap, and flap separation. CLINICAL DISCUSSION: Abdominal flap has been the commonly used technique but has the disadvantage of being bulky. Glove-like abdominal flap, a subcutaneous layer plane flap, can be performed simply, safely, and briefly. It has been published mainly for reconstruction for acute burn hand injuries, not for burn hand contracture. CONCLUSION: The use of modified glove abdominal flap technique for reconstruction in hand burn contracture gives a satisfactory result in terms of functional and aesthetic outcome and can be an option in reconstruction in contracted dorsal hand and fingers.

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Hand burns are common injuries that can result in long-term impairment of hand function. Enzymatic debridement (ED) prevents damage to the viable dermis due to the procedure's selectivity and has become an option for obtaining an accurate depth assessment and enabling wound re-epithelialization with less skin graft use. We conducted a prospective study from July 2015 to July 2018, which enrolled patients with deep partial-thickness hand burns and treated them with ED using bromelain. After a specified period, we assessed the patients' hand function, using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHOQ) to assess their disabilities and activities of daily life, respectively. We assessed the hand joint range of motion using a goniometer and assessed scar quality with the Vancouver Scar Scale (VSS). We analyzed 72 patients with 90 burned hands at 3 months and, at the final assessment, 69 patients with 86 burned hands. Fire was the most common cause of the burns. Bromelain allowed for early debridement (73.6% during the first 24 h). At the 3-month evaluation, the mean DASH and MHOQ scores were 2.35 and 97.9%, respectively, with a high inverse correlation between the 2 types of scores (Spearman's rho, -0.78; p < .001). The mean wrist flexion and extension were 85.7 and 80°, respectively, the mean metacarpophalangeal flexion was 88.3°, the proximal interphalangeal (PIP) flexion was 112.9°, and the thumb opposition was 77°. The mean VSS score was 2.87. At the final evaluation, with a minimum follow-up of 391 days, the mean DASH and MHOQ scores were 0.18 and 99.71%, respectively. ED with bromelain in deep partial-thickness hand burns resulted in normal values at 3 months and at over 1 year of follow-up, with complete restoration of function and quality of life and good scar results.

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Two therapeutic options for deep dermal hand burns are autologous split-thickness skin graft (STSG) following tangential excision and the application of the temporary wound dressing Suprathel following removal of burn blisters. We compared elasticity and perfusion of burn scars after both types of therapy at least one year after completion of treatment. A case series of 80 patients of our department with deep dermal hand burns between 2013 and 2018 was examined in the year 2019 at least one year after completion of treatment (24 females and 56 males with a median age of 47.6 years). The clinical assessment of the scar was performed with the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) and the objective assessment with suction cutometry (MPA 580) and an O2C device on both hands. Our statistical analysis showed no statistically significant differences for the R2 and R5 elasticity values between the two types of therapy. The 95% confidence intervals for the ratios of elasticity, and microcirculatory perfusion parameters and scar scale scores of burn scars to respective healthy areas of skin after STSG and Suprathel-therapy mostly covered 1. Subgroup analysis of R2 viscoelasticity and analyses with adjustments for scar compression therapy, nicotine consumption, age, palmar or dorsal localization of the burn scar and interactions of age with smoking and localization gave similar results. The adjusted analysis of SO2 showed statistically significant lower SO2 values, 9% less, after STSG compared to Suprathel treatment. Split-thickness skin graft following tangential excision and the application of Suprathel following removal of burn blisters may be equivalent options for treatment of deep dermal hand burns. To detect possible small differences, further studies with larger samples are required.

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BACKGROUND: Severe burn injuries to the hand impact multiple domains of function and participation. Measurement of outcomes after hand burn injuries is multifaceted and is influenced by several variables. OBJECTIVE: The aim of this systematic review was to review outcome measures reported in studies used to measure outcomes after severe hand burn injuries; and to critically evaluate the reliability, validity and clinical utility of each hand assessment tool identified from the literature to determine suitability for use with the burn's population. DATA SOURCES: A search of the published literature using electronic data bases MEDLINE, CINAHL, PEDro, OT seeker and PubMed was undertaken. Studies were included if they reported assessment tools and outcome measures used to determine hand function after severe burn injuries; were published in English and available in their full-length. Studies were excluded if they were related to a group under 18 years of age. RESULTS: Thirty-four papers were included in this systematic review. A total of 25 outcome measures were confirmed for inclusion in this paper and each underwent further evaluation to identify their psychometric properties. LIMITATIONS: A factor which could cause bias in this systematic review was the search was restricted to English language journals therefore excluding any primary papers in other languages. Mapping of the outcome measures to the ICF was conducted by the primary author which may give rise to bias however a member checking was conducted in order to remove this bias. CONCLUSIONS: This review established that no one outcome measure meets all the psychometric properties of validity, reliability and responsiveness SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO: CRD42018085059.

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INTRODUCTION: Even if they represent only 2.5 % of the total body surface area, the hands are burnt in 50 % of hospitalized patients. The risk of sequelae is significant, especially in children, human being in full growth, and a source of aesthetic and functional handicap. The aim of this study is to research the predictive factors of sequelae, to study their treatment of and their evolution. MATERIAL AND METHODS: We included children under six years of age with deep palmar burns of the hand between 1998 and 2008. Demographics, characteristics of the initial burn and its treatment were noted. Then, we studied the types of hand burn sequelae and their treatment. Finally, we observed their evolution over time with an aesthetic and functional evaluation and their impact on quality of life. RESULTS: Forty-nine children, representing 70 hands, were included in the study. The mean age at the time of the initial burn was 16.2 months (6; 60). The initial treatment was directed healing in 39 % of cases and thin skin excision-grafting in 61 % of cases. The type of sequelae most represented was bridle in 73 % of cases. Treatment consisted of rehabilitation measures (13 %) or surgery (69 %). The mean age at the time of surgery was 10.1 years (4; 19). These were plasties (62 %), total skin grafts (15 %) or a combination of both (23 %). The current follow-up is 16.2 years. The aesthetic result is considered good in 52 % of cases, the functional result is good in 78 % of cases. The impact on the quality of life is low and the parents are satisfied with the initial care. CONCLUSION: The treatment of the sequelae of burnt hands gives good results but involves well-conducted rehabilitation and regular monitoring. The treatment period must be adapted and the surgery simple, effective and specific to the type of sequelae.

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Hand burns are frequently seen in children, often resulting in digital flexion contractures. Traditional split-thickness or full-thickness skin grafts leave notably different skin texture and hyperpigmentation. The purpose of this study was to describe our operation for treating digital flexion contractures with full-thickness plantar skin grafts, and to evaluate the appearance and function outcomes. Hematoxylin and eosin staining, Masson trichrome staining and Melan A (marker of melanocyte) staining were used to evaluate palmar skin, plantar skin, groin skin and burn scars. Full-thickness plantar skin grafts were performed between 2008 and 2015 in 24 hand burn patients with digital flexion contracture. The average age at the time of surgery was 39.3 months and the average follow-up period was 5.5 years. The functional and cosmetic results were assessed. Plantar skin shared similar attributes with palmar skin histologically. Both plantar skin and palmar skin did not express melan A. All of the skin grafts survived well without hematoma, infection and necrosis. The grafts resembled the adjacent normal skin in regards to appearance and texture. The average TAM (total active movement) degree for the fingers was improved from 152.3° to 238.5°. The average VSS (Vancouver Scar Scale) score decreased dramatically from 10.4 to 1.1. Twenty one of twenty four patients (21/24, 87.5%) were very satisfied with function and appearance, and three in twenty four (3/24, 12.5%) were somewhat satisfied. This study indicates that full-thickness plantar skin grafts can achieve a satisfactory appearance and good function for hand burn child patients with digital flexion contractures.

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Burns are devastating injuries that cause significant morbidity, emotional distress, and decreased quality of life. Advances in care have improved survival and functional outcomes; however, burns remain a major public health problem in developing countries. More than 95% of burns occur in low- and middle-income countries, where access to basic health care is limited. The upper extremity is involved in the majority of severe burn injuries. The purpose of this article is to review upper extremity burn epidemiology, risk factors, prevention strategies, and treatment options in resource-limited settings.

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INTRODUCTION: Antibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds. METHODS: Children with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant. RESULTS: Ninety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40-0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag® (4% versus 27%; p = 0.004). CONCLUSION: Our study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag® for pediatric extremity burn injuries. LEVEL OF EVIDENCE: Treatment study; Level 1.

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