Reconstruction of the burned hand.

There is no "cookbook" for reconstructing the burned hand. Multiple issues can color the chances for a successful outcome. What is the endpoint of surgical effort? Is it when the patient tires, becomes discouraged, or ceases to return? These questions are not rhetorical. Whereas an appendectomy cures appendicitis, no single surgical procedure or series of procedures cures burns. Many patients spend their lives searching to be as they were preinjury. Although physicians as healers do not want to destroy hope, ethics command that we attempt to keep these patients focused on reality. Although there is always something that could be done, judgment dictates what should be done. The major goals are early independence and resumption of preburn lifestyle for the patient. A thoughtful surgical plan set up in conjunction with the burn team and with timed goals gives the patient the best chance for success.