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Acute Hand Burns in Children: Management and Long-Term Outcome Based on a 10-Year Experience With 698 Injured Hands

Sheridan, Robert L. MD; Baryza, Mary J. MS, PT, PCS; Pessina, Monica A. OTR; O'Neill, Kim M. OTR/L; Cipullo, Hilary M. MS, PT; Donelan, Matthais B. MD; Ryan, Colleen M. MD; Schulz, John T. MD, PhD; Schnitzer, Jay J. MD, PhD; Tompkins, Ronald G. MD, ScD

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Objective To document long-term results associated with an coordinated plan of care for acutely burned hands in children.

Summary and Background Data Optimal hand function is a crucial component of a high-quality survival after burn injury. This can be achieved only with a coordinated approach to the injuries. Long-term outcomes associated with such a plan of care have not been previously reported.

Methods Over a 10-year period, 495 children with 698 acutely burned hands were managed at a regional pediatric burn facility; 219 children with 395 injured hands were followed in the authors' outpatient clinic for at least 1 year and an average of >5 years. The authors' approach to the acutely burned hand emphasizes ranging and splinting throughout the hospital stay, prompt sheet autograft wound closure as soon as practical, and the selective use of axial pin fixation and flaps. Long-term follow-up, hand therapy, and reconstructive surgery are emphasized.

Results Normal functional results were seen in 97% of second-degree and 85% of third-degree injuries; in children with burns involving underlying tendon and bone, 70% could perform activities of daily living and 20% had normal function. Reconstructive hand surgery was required in 4.4% of second-degree burns, 32% of third-degree burns, and 65% of those with injuries involving underlying bone and tendon.

Conclusions When managed in a coordinated long-term program, the large majority of children with serious hand burns can be expected to have excellent functional results.

From the Shriners Burns Hospital, the Department of Surgery, Massachusetts General Hospital, and the Department of Surgery, Harvard Medical School, Boston, Massachusetts

Presented at the 30th Annual Meeting of the American Burn Association, Chicago, March 1998.

Supported by the Shriners Hospitals for Children and the National Institutes of General Medical Sciences (P50 GM21700 and T32 GM07035).

Correspondence: Robert L. Sheridan, MD, Assistant Chief of Staff, Shriners Burns Hospital, 51 Blossom Street, Boston, MA 02114.

Accepted for publication July 24, 1998.

© 1999 Lippincott Williams & Wilkins, Inc.