LASER-DOPPLER EVALUATION OF BURNED HANDS PREDICTS NEED FOR SURGICAL GRAFTING

Management of deep dermal hand burns represents a difficult clinical p roblem for the burn team because bedside estimation of burn depth is u nreliable, Early identification of full-thickness injury and prolonged healing times might result in the decision to perform surgical excisi on of eschar and skin grafting of the wounds, Such a strategy may impr ove overall functional and cosmetic results of hand burn treatment, Th is report concerns a 2-year study of 31 patients with 43 burned hands using the LD6000 helium-neon laser Doppler flowmeter, After obtaining informed consent, burned areas of the hand were evaluated on days 1, 3 , and 5 after burn, Results were reported as flow (mV), representing t he quantity of moving erythrocytes multiplied by erythrocyte velocity in the capillary tissue, The reported volume in percentage of Doppler- shifted light represented only the quantity of moving erythrocytes, Me dian flow values in nongrafted hands were 150 mV; in those requiring s kin grafts, median flow values were 89 mV, Flow values were significan tly greater in nongrafted compared,vith grafted hand burns on days 1 a nd 5, Volume values were not associated with whether or not grafting w as performed, Median volume values, however, did allow determination o f whether the burns would spontaneously heal within 15 days (high grou p) or if a mean of 42 days would be required (low group), Functional a nd cosmetic outcomes were determined by retrospective chart review, wh ich revealed comparable results regardless of grafting and regardless of short or prolonged healing times, Laser Doppler flowmetry may serve as a valuable adjunct to the prediction of the need for grafting and time to wound closure, Standardization of flowmetry data and technique s of evaluation are desirable, Spontaneous healing should be the goal in the majority of deep dermal hand burns.