title: Indications and Predictors for Reconstructive Surgery After Hand Burns.
abstract: OBJECTIVE
  The objective of this study was to analyze the prevalence, indications, and type of reconstructive surgery and predictors of the outcomes of reconstructive surgery after hand burns.
  
  
  METHODS
  A retrospective cohort study was conducted that included all patients admitted with acute hand burns in the Dutch burn centers from January 1998 through December 2002. The details of reconstruction including frequency, timing, indication, and techniques were collected over a 10-year follow-up period.
  
  
  RESULTS
  Hand burns were seen in 42% (n = 562 of 1,334) of all patients admitted with acute burns. Reconstructive surgery during the 10-year follow-up period was required in 15%. Contractures, especially of the first web space and little finger, were the most frequent indications for reconstructive surgery. Web spaces 1 to 3 and the little finger were the location most frequently operated on. The most frequently performed surgical technique was release of the contractures and the use of a random flap. Eighty percent of the reconstructive surgery patients required more than 1 reconstructive procedure, most often within 2 years of the initial injury. Secondary operations at the same location were required in 12%. In 40% of the patients, the first reconstructive surgery was performed within the first postburn year. Significant independent factors related to the need for reconstructive hand surgery were a larger area of full-thickness burns and surgical treatment of the hand during the acute phase.
  
  
  CONCLUSIONS
  Reconstructive surgery was required in 15% of patients who sustained hand burns. The majority of the patients requiring reconstructive surgery of the hand needed 2 or more operations to correct the contractures of the hand. Contractures of the little finger and first web space were the locations most frequently operated on. Patients with more extensive burns and who required hand surgery during the acute phase were more likely to need reconstructive surgery.
  
  
  METHODS
  Prognostic IV.
authors.affiliation: Department of Surgery, Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands; Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, the Netherlands. Electronic address: vliesc@maasstadziekenhuis.nl.
authors.forename: C H
authors.initials: CH
authors.lastname: van der Vlies
authors.affiliation: Department of Surgery, Burn Centre, Maasstad Hospital, Rotterdam, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: de Waard
authors.affiliation: Department of Plastic Surgery, Medical Centre, Leeuwarden, the Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hop
authors.affiliation: Association of Dutch Burn Centres, Martini Hospital, Groningen, the Netherlands.
authors.forename: M K
authors.initials: MK
authors.lastname: Nieuwenhuis
authors.affiliation: Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University, Amsterdam, the Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Middelkoop
authors.affiliation: Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: van Baar
authors.affiliation: Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University, Amsterdam, the Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands.
authors.forename: P P M
authors.initials: PPM
authors.lastname: van Zuijlen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002056:Burns / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003286:Contracture / Q000209:etiology / Q000601:surgery; D005260:Female; D006230:Hand Injuries / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: Hand burns