Burns of the hand.

Estimating the depth of burns of the hand remains difficult and requires considerable experience. One reason for this is that the depth of the burn can change in the first three days as a result of vascular spasm and thrombotic processes in the microcirculation of the skin. Extensive burns over the rest of the body and edema development also influence skin perfusion. The pathophysiological changes of thermal injury of the hand are discussed together with the interaction between infection reaction, edema development and mobility. The guidelines for primary treatment of burns of the hand are discussed. In essence the therapy consists of closing the skin as soon as possible, to eliminate the edema and to prevent infection. Recently a clear controversy has developed between conservative treatment or surgery of deep second degree burns and deep mixed burns of the hand. The advantages and disadvantages of these two therapies are discussed.