الفهرس 
Introduction
Cold injuryOnly 14 pages are availabe for public view
 |  | from | 131 |  |  |
| | | from | 131 | | |
Abstract
Introduction: The hands are considered the most vulnerable part of the body to trauma as they participate in daily activities. The hands are burned when it try to protect other parts of the body from thermal injuries. Thermal injuries of the hand constitute about 6% of all hand traumas and unless it managed properly, it may end in serious hand disabilities. Burns of the hand are classified according to depth into three degrees. First and superficial second-degree burns are managed usually by local therapy either with silver sulfadiazine1% cream or MEBO, which is superior to silver sulfadiazine1% cream. Immediate physiotherapy is encouraged and burn wounds are healed usually in 7 to 14 days with minimal complications. Deep second and third degree burns are considered a surgical challenge as patients need to restore their hand function rapidly and to have an acceptable aesthetic appearance in order to restore the functional, social and communicational activities of the hand. Early identification of compartmental syndrome and immediate escharotomy is crucial in the management of circumferential and third degree burns of the hand. Deep second and third degree burns are treated by surgical excision of the burn wound and coverage with split thickness skin grafts. The timing of such surgical intervention is controversial; some authors advocate early excision of deep burn wound and skin grafts during the first 3 to 5 days while others believe that doing the operation after two weeks of dressings may end into satisfactory results without any hazards to the general condition of the patients. Early surgical excision and skin grafts is considered to patients with burns confined to the hands or when the total burn surface area is less than 25%. Late intervention is advocated when the general condition of the patient does not withstand the operation or when the priority is to maintain survival, as when the total burn surface area is more than 25% or in critically ill patients. Early burn wound excision and skin graft is considered the standard method for management of deep burns of the hand. It has good aesthetic and functional results with minimal complications. Hospital stay and costs are less. The patient rarely needs a secondary corrective surgery. It should be emphasized that whatever the method of treatment, the patient should start physiotherapy as early as possible to get good functional results. After achieving a stable wound coverage, wearing of pressure garments is essential for the function and the aesthetic appearance of the hands. It is noticed that despite the considering of all precautions, some patients need a secondary corrective surgery, and that is why the protocols used in the treatment of burned hand should be updated continuously to decrease the patient sufferings, rate of secondary corrective surgeries and social costs. Aim of work: Our review discuss the importance of performing early esharectomy and skin grafting of deep burns of the hands, whenever possible, in order to achieve best results and shows its utility in reducing re-admissions for secondary revisions. Identification of the types of unsatisfactory outcomes after surgery. Identification of the main secondary corrective procedures performed. Conclusions: Identification of the depth of injury in the burned hand is essential for the proper management. The treatment of superficial burn wound is conservative while it is mainly surgical for deep burn wound. Compartmental syndrome should be prevented by proper escharotomy. Early surgical intervention in deep hand burns is associated with better results. Physiotherapy should start as early as possible to optimize the results.