Coffey, Michael J. MD; Thirkannad, Sunil M. MD
From the Christine M. Kleinert Institute for Hand and Microsurgery Louisville, KY.
This study was not supported by any outside funding.
Address correspondence and reprint requests to Sunil M. Thirkannad, MD, Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way, Suite 850, Louisville, KY 40202. E-mail: firstname.lastname@example.org.
We have been treating patients with partial- and/or full-thickness burns of the hand using an easy and inexpensive technique called the glove-gauze method. Nine patients with 11 burned hands were treated with the glove-gauze regimen and monitored weekly for wound healing and range of motion. Excellent results were achieved in all patients who complied will full follow-up. This method is simple, accessible, safe, and extremely cost-effective and allows for immediate active mobilzization. We recommend use of the glove-gauze method for treating all burns of the hand that do not involve the underlying fascia, muscle, epitenon, paratenon, and/or bone.
The upper extremity has been reported to be the most commonly burned part of the human body, with partial-thickness burns representing most upper extremity burns.1 There are many treatment modalities currently used in the care of burns of the hand, including topical antibacterial agents covered with a gauze wrap or expensive topical dressings and bioengineered skin substitutes.2,3 We have been treating patients with partial- and/or full-thickness burns of the hand using an easy and inexpensive technique we call the glove-gauze method. We describe here our technique along with an analysis of results in 9 patients with 11 burned hands.
We use the glove-gauze method in all first- and second-degree burns as well as third-degree burns smaller than 1 cm2 that do not involve the underlying fascia, muscle, epitenon, paratenon, and/ or bone.
After thorough cleansing and debridement, the wound is anointed with 1% silver sulfadiazine cream. The affected hand is then covered with an oversized sterile surgical glove during daytime (Figs. 1 and 2), which allows full active and passive mobilization to be commenced immediately (Fig. 3). At night, when less active range of motion is anticipated, the patient is instructed to remove the glove, reapply a coat of silver sulfadiazine cream, and wrap the burns in a dry gauze dressing. The patient is taught to repeat this regimen of a glove during the day and a gauze wrap at night. Occasionally, accumulations of serous drainage under the glove lead to some discomfort. In such instances, the patient is advised to remove the glove, wipe the area, and then air-dry the wound before reapplying the glove.
All patients are followed up weekly until complete healing is achieved. During follow-up, patients are evaluated for progress of wound healing and maintenance of range of motion.
Nine patients with 11 burned hands treated with the glove-gauze regimen were evaluated. There were 8 men and 1 woman, ranging from 24 to 65 years of age, and all were right-hand dominant. Three patients sustained a combination of first- and second-degree burns, 3 patients had only second-degree burns, 1 patient had a combination of second- and third-degree burns, 1 patient sustained only third-degree burns, and 1 patient had a combination of first-, second-, and third-degree burns.
Full healing using the glove-gauze method was observed in 8 of 11 hands (Fig. 4). The 2 patients (accounting for 3 burned hands) for whom documentation of full healing is not available were both healing well with full range of motion after 1 and 2 weeks of follow-up, respectively. They did not keep their subsequent appointments, and we have strong reason to believe that their burns did heal. Full range of motion was achieved from the first day of treatment and maintained throughout the treatment period in 10 of 11 hands (Fig. 5). One patient developed a 5-degree flexion contracture of the proximal interphalangeal joint of the small finger. However, as this deformity was of no functional significance, the patient did not seek any further treatment for it.
The strengths of this treatment modality lie in its simplicity, ease for implementing immediate active mobilization, and its cost-effectiveness. The dressing is easily applied by the patient without requiring assistance, facilitating patient compliance. It can even be applied by patients who are squeamish or wary of touching their wounds-they can simply dispense the silver sulfadiazine cream onto the wound, put on the sterile glove over the cream, and then evenly distribute the cream with their other hand using the glove as a barrier. With the oversized surgical glove dressing in place, the patient can actively mobilize the burned hand, whereas gauze dressings, which are typically otherwise used, restrict mobilization. The ability to immediately mobilize the burned hand using this method allows patients to return to work because the sterile surgical glove and silver sulfadiazine cream also act as a waterproof antimicrobial barrier.
We have successfully used the glove-gauze method in all first- and second-degree burns. We have also used this method in third-degree burns smaller than 1 cm2 that do not involve underlying vital structures such as fascia, muscle, epitenon, paratenon, and/or bone. In third-degree burns that are less than 1 cm2, spontaneous healing has occurred in all our cases, without the need for any secondary coverage procedures. We have not had any patients with third-degree burns that are larger than this in our series. Nonetheless, it is expected that larger areas of third-degree burns may require procedures for coverage in the form of skin grafts or flaps.
Finally, the glove-gauze method is cost-effective when compared with "technologically-advanced" topical dressings and bioengineered skin substitutes. A 50-g tube of silver sulfadiazine cream typically costs $20, and a pair of size 9 sterile surgical gloves typically costs as low as $2. Acticoat (Smith & Nephew, UK) is a silver impregnated barrier dressing for burns2 and costs approximately $177 for one 7-day dressing. Biobrane (Dow Hickam/Bertek Pharmaceuticals, Sugar Land, Tex) is a biosynthetic dressing composed of a mesh coated with porcine polypeptides that is placed on the wound and trimmed away as the wound heals3 and costs approximately $50 for a 5 × 5-in sheet. TransCyte (Advanced BioHealing, Inc, La Jolla, Calif) is a temporary skin substitute that consists of a nylon mesh coated with porcine collagen and fibroblasts3 and has a cost upward of 10 times that of Biobrane. These bioengineered skin substitutes have been shown to be at least as effective as topical silver sulfadiazine3; however, the good results we have achieved using the glove-gauze regimen make us wonder whether the high costs of using these newer biosubstitutes are truly justifiable.
We have successfully used the glove-gauze regimen to treat both partial- and full-thickness burns of the hand. The method has proven to be simple, accessible, safe, and extremely cost-effective. It allows for immediate active mobilization and has hence ensured excellent results in all our patients.
1. Fagenholz PJ, Sheridan RL, Harris NS, et al. National study of emergency department visits for burn injuries, 1993 to 2004. J Burn Care Res 2007;28(5):681-690.
2. Kok K, Georgeu GA, Wilson VY. The acticoat glove-an effective dressing for the completely burnt hand. Burns 2006;32(4):487-489.
3. Pham C, Greenwood J, Cleland H, et al. Bioengineered skin substitutes for the management of burns: a systematic review. Burns 2007;33(8):946-957.
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