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Standard Management of Acute Hand Burns: Results From a Survey of American Burn Association-Verified Burn Centers
Alexander J Comerci, BS; Mario Alessandri Bonetti, MD; Hilary Y Liu, BS; Siddhi Shockey, BA; Alain C Corcos, MD, FACS; Jenny A Ziembicki, MD; Guy M Stofman MD; Francesco M Egro, MD, MSc, MRCS
University of Pittsburgh School of Medicine
2024-01-15
Presenter: Alexander J Comerci
Affidavit:
J. Peter Rubin
Director Name: J. Peter Rubin
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Background: Hand burns have a significant impact on the long-term function of burn patients. Recently, new protocols and technologies, such as dermal substitutes, have been introduced for the treatment of hand burns. In this cross-sectional study, we aim to investigate the current standard of care and the role of dermal substitutes in treatment.
Methods: A cross-sectional study was conducted in November 2023. A 9-question survey related to acute hand burns management was sent to 64 directors of ABA-verified burn centers.
Results: Thirty-three respondents (51.6%) reported their standard of care for acute hand burns. Hand burns are managed in 63.6% by burn surgeons only, 21.2% by either burn or plastic surgeons, and 15.2% by plastic surgeons only. For the treatment of superficial partial-thickness hand burns, directors preferred a non-operative approach (90.9%). Most respondents chose single-stage excision and skin graft for deep partial-thickness hand burns (75.8%) and full-thickness hand burns (51.5%). However, for full-thickness hand burns, some surgeons preferred a two-stage reconstruction involving excision and placement of a skin substitute (24.2%) or allograft (9.1%), followed by a skin graft. Among 30 respondents who use dermal templates for hand burns, Integra (36.7%) and Novosorb-BTM (20.0%) were preferred. The top reasons for choosing one specific dermal substitute were the surgeon's preference (63.3%) and cost (30.0%).
Conclusion: Excision and skin grafting as a one-stage procedure remains the standard of care for hand burns. Future randomized controlled trials should measure the real benefit of dermal regenerative templates in improving aesthetic and functional hand burn outcomes.
