The management of acute thermal injuries to the upper extremity.

In summary, although thermal injuries of the upper extremity can produce permanent functional compromise, intelligent management of burns of the hands and fingers can produce fully functional and cosmetically acceptable hands. When the dorsal aspects of the hands alone are injured by thermal insult, the immediate excision of the burned tissue and replacement by split-thickness skin grafts will produce functional and esthetically satisfying results. Should immediate excision and grafting be contraindicated because of massive burns of the body, management by application of topical antibacterial agents and dressings is possible. With this treatment, carefully supervised exercises are mandatory. Revisions of hypertrophic and contracted scars can be done at a later date. The stiff and painful hand is not the direct consequence of thermally destroyed skin, but is due instead to the metabolic and biologic complications of unhealed burn wounds. It follows, therefore, that the burn illness should preferably be terminated by prompt excision of the eschar and wound closure by the application of split-thickness skin grafts.