Management of finger deep burns: The interest of local flaps

Use of HEMHealing, an Oxygenating Dressing in the Treatment of a Full-thickness Burn on the Fingertips

The optimal treatment for full-thickness burn injuries involves surgical intervention, which may include skin grafting or reconstruction by flap. The complexity of treatment arises from the need for both effective temporary wound coverage and permanent skin restoration while also considering the potential risk of finger amputation in the case of hand burn. A 22-year-old woman sustained a thermal burn of three fingers while participating in an art activity involving wax hand molding. Initial treatment with a standard oily dressing did not yield satisfactory results, and the option to try HEMHealing was offered, a new oxygenating biological gel dressing, resulting in progressive debridement, granulation, and epithelialization of the wound. Complete healing was achieved within 10 and 15 days for the second and fourth fingers, respectively, and within 8 weeks for the third finger. The use of HEMHealing, in this case, most likely contributed to accelerating wound healing, promoting the growth of new tissues, improving local tissue oxygenation, and avoiding a disabling distal amputation.

Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature

INTRODUCTION

Advances in the evidence base of acute thermal hand burns help to guide the management of these common injuries. The aim of this literature review was to evaluate recent evidence in the field over 10 years.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols methodology was used as a guide for this literature review. PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar were searched for English language articles related to hand burns published between 2009 and 2018 inclusive, and the Cochrane Library was reviewed. Exclusion criteria were as follows: participants younger than 18 years, scar or contracture management, rehabilitation, outcomes assessment, late reconstruction, and electrical or chemical burns.

RESULTS

An initial search retrieved 6493 articles, which was narrowed to 403 full-text articles that were reviewed independently by 3 of the authors and categorized. Of 202 included articles, there were 8 randomized controlled trials and 2 systematic reviews. Six evidence-based guidelines were reviewed. Referral of hand burns to specialist centers, use of telemedicine, early excision and grafting, and immediate static splintage have been recommended. Enzymatic debridement results in earlier intervention, more accurate burn assessment, preservation of vital tissue, and fewer skin grafts, and ideally requires regional anesthesia. Guidance on escharotomy emphasizes indication, technique and adequate intervention, and potential for enzymatic debridement. Inclusion of topical negative pressure, dermal regenerative templates, acellular dermal matrices, and noncellular skin substitutes in management has helped improve scar and functional outcomes.

DISCUSSION

The results of this literature review demonstrate that multiple national and international societies have published burns guidelines during the decade studied, with aspects directly relevant to hand burns, including the International Society for Burn Injuries guidelines. There are opportunities for evidence-based quality improvement across the field of hand burns in many centers.

CONCLUSIONS

More than 200 articles globally in 10 years outline advances in the understanding of acute management of thermal hand burns. Incorporating the evidence base into practice may facilitate optimization of triage referral pathways and acute management for hand burns.