Editor's choice| Volume 42, ISSUE 5, P351-358, May 2017

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Indications and Predictors for Reconstructive Surgery After Hand Burns

Published:March 27, 2017DOI:


      The objective of this study was to analyze the prevalence, indications, and type of reconstructive surgery and predictors of the outcomes of reconstructive surgery after hand burns.


      A retrospective cohort study was conducted that included all patients admitted with acute hand burns in the Dutch burn centers from January 1998 through December 2002. The details of reconstruction including frequency, timing, indication, and techniques were collected over a 10-year follow-up period.


      Hand burns were seen in 42% (n = 562 of 1,334) of all patients admitted with acute burns. Reconstructive surgery during the 10-year follow-up period was required in 15%. Contractures, especially of the first web space and little finger, were the most frequent indications for reconstructive surgery. Web spaces 1 to 3 and the little finger were the location most frequently operated on. The most frequently performed surgical technique was release of the contractures and the use of a random flap. Eighty percent of the reconstructive surgery patients required more than 1 reconstructive procedure, most often within 2 years of the initial injury. Secondary operations at the same location were required in 12%. In 40% of the patients, the first reconstructive surgery was performed within the first postburn year.
      Significant independent factors related to the need for reconstructive hand surgery were a larger area of full-thickness burns and surgical treatment of the hand during the acute phase.


      Reconstructive surgery was required in 15% of patients who sustained hand burns. The majority of the patients requiring reconstructive surgery of the hand needed 2 or more operations to correct the contractures of the hand. Contractures of the little finger and first web space were the locations most frequently operated on. Patients with more extensive burns and who required hand surgery during the acute phase were more likely to need reconstructive surgery.

      Type of study/level of evidence

      Prognostic IV.

      Key words

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        • Luce E.A.
        The acute and subacute management of the burned hand.
        Clin Plast Surg. 2000; 27: 49-63
        • Kamolz L.P.
        • Kitzinger H.B.
        • Karle B.
        • Frey M.
        The treatment of hand burns.
        Burns. 2009; 35: 327-337
        • Maslauskas K.
        • Rimdeika R.
        • Rapoliene J.
        • Ramanauskas T.
        Analysis of burned hand function (early versus delayed treatment).
        Medicina (Kaunas). 2005; 41: 846-851
        • Kreymerman P.A.
        • Andres L.A.
        • Lucas H.D.
        • Silverman A.L.
        • Smith A.A.
        Reconstruction of the burned hand.
        Plast Reconstr Surg. 2011; 127: 752-759
        • Moore M.L.
        • Dewey W.S.
        • Richard R.L.
        Rehabilitation of the burned hand.
        Hand Clin. 2009; 25: 529-541
        • Anzarut A.
        • Chen M.
        • Shankowsky H.
        • Tredget E.E.
        Quality-of-life and outcome predictors following massive burn injury.
        Plast Reconstr Surg. 2005; 116: 791-797
        • Schouten H.J.
        • Nieuwenhuis M.K.
        • van Zuijlen P.P.
        A review on static splinting therapy to prevent burn scar contracture: do clinical and experimental data warrant its clinical application?.
        Burns. 2012; 38: 19-25
        • Schneider J.C.
        • Holavanahalli R.
        • Helm P.
        • O'Neil C.
        • Goldstein R.
        • Kowalske K.
        Contractures in burn injury part II: investigating joints of the hand.
        J Burn Care Res. 2008; 29: 606-613
        • Prasad J.K.
        • Bowden M.L.
        • Thomson P.D.
        A review of the reconstructive surgery needs of 3167 survivors of burn injury.
        Burns. 1991; 17: 302-305
        • Sheridan R.L.
        • Baryza M.J.
        • Pessina M.A.
        • et al.
        Acute hand burns in children: management and long-term outcome based on a 10-year experience with 698 injured hands.
        Ann Surg. 1999; 229: 558-564
        • Sheridan R.L.
        • Hurley J.
        • Smith M.A.
        • et al.
        The acutely burned hand: management and outcome based on a ten-year experience with 1047 acute hand burns.
        J Trauma. 1995; 38: 406-411
        • Hop M.J.
        • Langenberg L.C.
        • Hiddingh J.
        • et al.
        Reconstructive surger after burns: a 10-year follow-up study.
        Burns. 2014; 40: 1544-1551
        • van Zuijlen P.P.
        • Kreis R.W.
        • Vloemans A.F.
        • Groenevelt F.
        • Mackie D.P.
        The prognostic factors regarding long-term functional outcome of full-thickness hand burns.
        Burns. 1999; 25: 709-714
        • Achauer B.M.
        • VanderKam V.M.
        Burn reconstruction.
        in: Achauer B.M. Eriksson E. Plastic Surgery: Indications, Operations, and Outcomes. Mosby, St. Louis2000: 425-446
        • Baux S.
        • Mimoun M.
        • Kirsch J.M.
        • Zumer L.
        • Berard V.
        Treatment of elbow contractures in burns.
        Burns Incl Therm Inj. 1987; 13: 241-244
        • Gardien K.L.
        • Marck R.E.
        • Bloemen M.C.
        • et al.
        Outcome of burns treated with autologous cultured proliferating epidermal cells: a prospective randomized multicenter intra-patient comparative trial.
        Cell Transplant. 2016; 25: 437-448
        • Gravante G.
        • Delogu D.
        • Esposito G.
        • Montone A.
        Versajet hydrosurgery versus classic escharectomy for burn debridement: a prospective randomized trial.
        J Burn Care Res. 2007; 28: 720-724
        • Krieger Y.
        • Bogdanov-Berezovsky A.
        • Gurfinkel R.
        • Silberstein E.
        • Sagi A.
        • Rosenberg L.
        Efficacy of enzymatic debridement of deeply burned hands.
        Burns. 2012; 38: 108-112
        • Schwarz R.J.
        • Joshi K.D.
        Management of post-burn contractures.
        J Nepal Med Assoc. 2004; : 211-217
        • Greenhalgh D.G.
        • Gaboury T.
        • Warden G.D.
        The early release of axillary contractures in pediatric patients with burns.
        J Burn Care Rehabil. 1993; 14: 39-42
        • Watson S.
        Hand burns.
        Repair Reconstr. 2001; 2: 2-4