The prognostic factors regarding long-term functional outcome of full-thickness hand burns

The treatment of the burned hand has always been a subject of special inter est. In order to obtain a better understanding of the parameters involved i n the long-term functional outcome of hand burns a retrospective study was performed on 88 consecutive patients with hand burns (143 hands), treated a ccording to a standardised protocol. Patients were followed for at least 12 months postburn. Hand function was assessed by the: seven objective test c riteria (7-OTC) described by Jebsen. Logistic regression analysis produced five parameters that were found to have a significant predictive value for long-term hand function. In order of predictive value, these were finger am putations, age on admission, impaired autograft take, the full-thickness ha nd burn surface area and the full-thickness total body burn surface area. B y fitting these five variables into an equation, a probability model was ob tained, which could be applied to estimate a prognosis concerning the final hand function of an individual patient with a hand burn. No relationship was found between the postburn day of operation and the lon g-term hand function. This finding is inconsistent with the current consens us that functional outcome is improved by early excision and grafting. In p ractice, it suggests that hand function is well preserved when burns of unc ertain depth are treated expectantly, followed by selective debridement and grafting. Advantages include reduced blood loss, no loss of vital tissue a nd a reduction of the need for donor sites. (C) 1999 Elsevier Science Ltd a nd ISBI. All rights reserved.