Principles for the treatment of hand burns In addition to the same basic treatment principles as “burn wound treatment”. The treatment of hand burns should strive to heal the wound as soon as possible and reduce tissue edema. Should try to reduce the occurrence of sequelae. Reduce the degree of deformity, early activities, maximize the recovery of hand function.
Changes in capillary permeability after burns, increased exudation, and local edema. These exudates often extend along the muscle cords become organized over time, leading to important elastic tissue.
The fine tendon sheaths, fascia, hand muscles, and hard joint capsules are all restricted by fibrous tissue, resulting in joint stiffness and dysfunction. In severe cases, “frozen hands” may occur.
Therefore, it is important to reduce the degree of edema and shorten the time of edema. The main measure is to move early and raise the affected limb. The hand should be higher than the elbow and the elbow should be higher than the shoulder.
If the forearm, wrist, and fingers have circular constrictive deep burns that affect the circulation of the hand, an eschar incision should be performed for decompression.
Eliminate wounds as soon as possible
This is the most basic principle for handling hand burns, and it is also a fundamental measure to maximize hand function preservation. This is because if the wound is exposed for a long time, especially when the necrotic tissue of a deep burn is not removed.
It will inevitably cause infection and deepen the wound. If the granulation tissue is allowed to grow without skin grafting, relying on the few remaining epithelial cells to heal barely, scar hyperplasia, contracture and deformity will occur.
In addition, the long-term existence of wounds restricts the early movement of hands due to pain and other reasons, resulting in muscle atrophy and joint stiffness. Therefore, hand wounds should be treated first. If the whole body condition permits.
It is advisable to remove or cut off the eschar or crust of the deep burn of the hand as soon as possible, and carry out skin grafting to cover the wound. Those who fail to cut the scab in the early stage should actively remove the necrotic tissue and skin graft as soon as possible, or remove the old granulation tissue and then graft the skin.
Generally, those who can eliminate the wound within 3 weeks have better functional recovery, and those who have more than 3 weeks have obvious joint dysfunction.
Prevention of infection
After wound infection, deep second-degree wounds can be transformed into third-degree wounds. In severe cases, tendons can be damaged or arthritis can occur. The key to control infection is to remove the necrotic tissue as soon as possible. For deep burns, exposure therapy is best to quickly dry the eschar, or topical medication to reduce bacterial concentration and prevent invasive infections. Early activities
In addition to edema after burns, which restrict joint activities like splints. eschar formation on the wound or bandaging treatment also hinders activities.
If you do not pay attention, keeping the hand fixed for a long time will further cause pathological changes in the deep tissues. Causing all the structures of the hand, muscle atrophy, tendon adhesion, joint stiffness and hardening. Resulting in permanent deformity and loss of function.
This can not only achieve the purpose of physical therapy. However, also inspire the confidence and courage of the wounded to fight against the disability, and fully mobilize their enthusiasm.
Maintain the functional position of the hand
The injured often flex the wrist joint, hyperextension the metacarpophalangeal joint, flexion of the first interphalangeal joint. It adduct the thumb because of the fear of pain.
Deformities caused by deep burns of the back of the hand are mainly metacarpophalangeal joint hyperextension. Interphalangeal joint flexion, loss of palmar arch, thumb adduction, and wrist adduction.
Treatment of superficial second-degree burns of the back of the hand
If the superficial back of the hand burns can avoid infection, it can heal itself. No scars or dysfunction after healing. Exposure or bandaging therapy can be used. After cleaning, use effective antibacterial drugs for external use. After several dressing changes, it can heal by itself. However, after healing, you should continue to strengthen functional exercises. After That, local compression bandaging. Fix your hands in functional or anti-contracture positions at night to obtain the maximum therapeutic effect.