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 eff ect on the outcome of hand function.Th is study conducted to compare the results of the EE and G and delayed skin grafting in deep hand burns regarding the hand functional outcome. Materials and Methods: Th is 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. Th e patients were placed into early excision (No. =30) and delayed excision group (No. =30).Total active motion (TAM) of fi ngers, 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: Th e 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 diff erence was not signifi cant (P = 0.23). After 6 months, the average of the TAM and grip strength in the EE and G group was signifi cantly more than that of the delayed group (P < 0.0001 and P = 0.019). Conclusion: Th e present study showed that EE and G with proper physical therapy and rehabilitation management provides a higher functional outcome in dorsal deep burned hand.

Key words: Active motion of fi ngers, burned hand, early excision and grafting, grip strength, hand function