Early excision and skin grafting versus delayed skin grafting in deep hand burns (a randomised clinical controlled trial).
BACKGROUND
Early excision and grafting (E&G) of burn wounds has been reported to decrease hospital stay, hospital costs and septic complications, and some purport reduced mortality while decreasing hospital costs. In today's practice, all burn wounds unlikely to achieve spontaneous closure within 3 weeks are excised and grafted. Early studies did not demonstrate dramatic differences in cosmetic or functional results. This is particularly true with burns of the face, hands and feet. In this study, early excision and skin grafting was compared with delayed skin grafting in deep hand burns.


METHODS
From September 2006 to February 2008, 50 patients with hand burns and average burn size less than 30% total body surface area (TBSA) deep second- and third-degree were randomly divided into early E&G group (group I) and delayed grafting group (group II). Gradual and careful limb and digit range of motion was started on about 10th-14th postoperative day. We used a questionnaire based on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire to evaluate final functional outcome. Further, hypertrophic scar formation, contracture and deformities were followed and managed accordingly.


RESULTS
The most common site of involvement was the metacarpophalangeal (MCP) joint with frequency of 39% and 40% in groups I and II, respectively. There were no statistically significant differences between both groups regarding deformity severity, scar formation, sensation, major activities and overall satisfaction.


CONCLUSIONS
In treating burns of the hand, the primary goal should always be to restore the functionality of the hand. Although early surgery shortens the healing time and lessens the hospital stay, our results did not show any significant difference between these two methods regarding the function, scar formation, daily activity limitation and overall satisfaction.
Mohammadi
Ali Akbar
AA
Shiraz Burn Research Center, Division of Plastic Surgery, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran. mohamadiaa@sums.ac.ir
Bakhshaeekia
Ali Reza
AR
Marzban
Saeed
S
Abbasi
Siroos
S
Ashraf
Ali Reza
AR
Mohammadi
Mohammad Kazem
MK
Toulide-Ie
Hamid Reza
HR
Tavakkolian
Ahmad Reza
AR
D000203:Activities of Daily Living; D000328:Adult; D002056:Burns / Q000503:physiopathology / Q000601:surgery*; D002921:Cicatrix / Q000473:pathology; D004185:Disability Evaluation; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D016059:Range of Motion, Articular; D016038:Skin Transplantation; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult