title: Amputation Following Hand Escharotomy in Patients with Burn Injury.
abstract: OBJECTIVE
  Hand burns are commonly seen in patients with burn injury. In the past, focus was on lifesaving measures, but with advances in burn care during the last century, the paradigm shifted to digital salvage and eventually to functional digital salvage. Good outcomes are heavily dependent on the care that is rendered during the initial management of the burn.
  
  
  METHODS
  A retrospective medical record review was conducted through the Central Illinois Regional Burn Center Patient Registry. Patients with burn injury treated with upper extremity and hand escharotomy between January 1, 2000, and December 31, 2005, were included in the study.
  
  
  RESULTS
  We identified a total of 34 patients with 57 burned hands. Six hands required delayed amputation of digits despite recognition of neurovascular compromise and escharotomy, yielding a 10% amputation rate. No correlation could be drawn with regard to total body surface area, age, or sex.
  
  
  CONCLUSIONS
  Important principles in the acute phase include early splinting, recognition of the need for escharotomy and complete escharotomy when necessary, early excision and grafting, and involvement of occupational therapy for splinting and to guide both active and passive exercises. Although uncommon, some extremity burns may require subsequent amputation despite prompt attention and optimal treatment. In our case series, the need for amputation after successful escharotomies of salvageable digits was associated with full-thickness and electrical burns.
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Schulze
authors.affiliation: University of Louisville School of Medicine, Louisville, Ky.
authors.forename: Dexter
authors.initials: D
authors.lastname: Weeks
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky.
authors.forename: Joshua
authors.initials: J
authors.lastname: Choo
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield.
authors.forename: Damon
authors.initials: D
authors.lastname: Cooney
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield.
authors.forename: Alyssa L
authors.initials: AL
authors.lastname: Moore
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield.
authors.forename: Matt
authors.initials: M
authors.lastname: Sebens
authors.affiliation: Division of Plastic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Neumeister
authors.affiliation: Division of Plastic Surgery, Department of Surgery, University of Louisville School of Medicine, Louisville, Ky.
authors.forename: Bradon J
authors.initials: BJ
authors.lastname: Wilhelmi
keywords: amputation burn patient; burn patient escharotomy; hand burn; hand burn amputation; hand escharotomy