PROSPECTIVE OUTCOME ANALYSIS OF A PROTOCOL FOR THE SURGICAL AND REHABILITATIVE MANAGEMENT OF BURNS TO THE HANDS

Treatment protocols for the management of burned hands are essential f or integrating team efforts and achieving optimal functional results. Standard protocols are especially useful during mass casualty incident s, when the admission of multiple patients with large burns and/or ass ociated injuries may reduce the priority usually accorded the hands. W e prospectively evaluated a surgical and rehahilitative treatment prot ocol for burned hands during a mass casualty incident, after which 43 burn patients with 82 burned hands were admitted to one burn center. S oft-tissue management was individualized to achieve, if possible, woun d closure within 14 days, and included the use of topical antimicrobia ls, cutaneous debridement and/or tangential excision, biologic dressin gs, and split-thickness autografts. Range of motion therapy was based on daily measurement of active motion of the metacarpophalangeal joint s. Static splinting alternating with continuous passive motion every 4 hours was utilized for sedated patients. Continuous passive motion al ternating with active ranging and night splinting was utilized for met acarpophalangeal flexion <70 degrees. Active ranging and progressive r esistance was utilized for metacarpophalangeal flexion greater than or equal to 70 degrees. Sixty-four hands required excision and grafting, with SS percent having at least one autografting procedure corn plete d by postburn day 16. Total active motion of the hands treated average d 220.6 degrees on discharge and 229.9 degrees at 3 months alter injur y. Mean hand grip strength was 60.8 pounds at discharge and 66.0 pound s at 3 months after injury. Adherence to a standard hand burn protocol resulted in timely wound coverage and recovery of hand function for a large group of patients treated at a single burn facility after a mas s casualty incident.