title: Effects of early versus delayed excision and grafting on the return of the burned hand function.
abstract: BACKGROUND
  Despite a general consensus regarding the impacts of early excision and grafting (EE and G) of burned hand on the reducing of treatment cost and hospital stay, there are some controversial issues about its effect on the outcome of hand function. This study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome.
  
  
  METHODS
  This study was conducted from April 2012 to November 2013 in sixty patients with deep thermal burns of the dorsal hand with total body surface area (TBSA) <20% who were admitted to special burn hospital. After standard primary burn care and resuscitation, necessary procedures (EE and G or more conservative treatment) were performed based on the patients' conditions. The patients were placed into early excision (No. =30) and delayed excision group (No. =30). Total active motion (TAM) of fingers, grip strength of the hand and the assessment of disabilities of the arm, shoulder and hand questionnaire, were measured in all patients 6 months after grafting.
  
  
  RESULTS
  The average percentage of TBSA in the EE and G group was more than the delayed excision group (17.34% ±5.12% vs. 15.64% ±5.83%), this difference was not significant (P= 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was significantly more than that of the delayed group (P< 0.0001 andP= 0.019).
  
  
  CONCLUSIONS
  The present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.
authors.affiliation: Department of General Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Hamid
authors.initials: SH
authors.lastname: Salehi
authors.affiliation: Department of Plastic and Reconstructive Surgery, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Javad
authors.initials: MJ
authors.lastname: Fatemi
authors.affiliation: Department of General Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Sedghi
authors.affiliation: Department of Occupational Therapy, Burn Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mitra
authors.initials: M
authors.lastname: Niazi
keywords: Active motion of fingers; burned hand; early excision and grafting; grip strength; hand function