Hand burns are common with over 80% of burns involving the hands. Hand burns often require specialized treatment by plastic surgeons, hand surgeons, and burn units. Dallas plastic surgeon Dr. Azouz is able to treat many hand burns in acute and late settings.
The hands and fingers can be burned by a variety of mechanisms. Burns can be caused by thermal, electromagnetic, chemical, and electrical energy which wounds the skin. Thermal burns are from fire/flames, hot metals, boiling/scalding liquids, and steam. Radiation burns involve prolonged exposure to the sun or other sources of radiation, including x-rays. Chemical burns are from strong acids, detergents, cleaners, or solvents. Electrical burns are from electric currents. Burns of the hands commonly can be more severe when they happen at work.
Hand burns can be minor or first-degree, such as sunburns, or more severe which can damage skin, underlying bones, muscles, tendons, and nerves.
Hand burns usually require surgery when they are second, third and fourth-degree. Other indications for surgery include loss of function, contracture, scarring, loss of important anatomy, infection, deformity, nerve compression (carpal tunnel and cubital tunnel syndrome) and tendon entrapment ( such as trigger finger and de Quervain’s syndrome).
Surgeries are usually performed in stages. The first stage of burn surgery usually is debridement with the removal of dead tissue, tendons, skin, and bone. Skin grafts and flaps are placed soon after debridement. Hand nerves should usually be decompressed as soon as possible. The Release of contractures, tenolysis, and revision amputation is usually performed as secondary operations.
Dr. Azouz will use sedation with local anesthesia for the vast majority of hand surgeries. Patients are given sedative medications to help them relax and sleep. Dr. Azouz will then inject an axillary block which numbs the arm and helps with pain for up to 24 hours after the procedure.
The amount of time it takes for a burn to heal on the hand depends on the severity of the burn. Minor burns such as first-degree burns will typically heal in a week. Second-degree burns affecting the outer and inner layers of the skin can take a few weeks to heal. Second-degree burns sometimes require surgery. Third and fourth-degree burns involving all the layers of the skin can take several months to heal and will often require hand surgery. With any burn on the hands, it is important to seek treatment from a hand and burn specialist.
Minor burns of the hands and fingers are usually treated with cool running water, clean bandages, and antiinflammatories and should be kept clean. It is important to see a hand specialist as soon as possible to help prevent infection and perform surgery as needed.
For acute burns, it is generally not recommended to put moisturizer on the burn immediately because some moisturizers can contribute to infections. Fragrances and other ingredients in the moisturizer can lead to infection. For burns that have healed hand surgeons usually recommend the use of an oil-free, fragrance-free moisturizer that is water-based.
The recovery from surgery on the hands and fingers depends on the extent of the burn and surgery. In general severe burns can result in a lengthy healing process needing multiple procedures, many follow-up appointments, hand therapy, and medication management.
Immediately after burn surgery, Dr. Azouz will routinely place a splint after the procedure to help the affected area heal well. Recovery can vary depending on the procedure. Therapy may be recommended to help regain range of motion and strength. Most patients can return to their activities in 4-6 weeks.
The cost of surgery ranges broadly. Dr. Azouz will obtain a medical history and perform a physical examination to help determine the cost. Worker’s compensation insurance will usually cover the costs of burn care and the subsequent surgery, therapy, and rehabilitation as needed.
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