Management of the acutely burned upper extremity.

In summary, thermal injury is a frequent from of upper extremity trauma that often affects young working-class males. Its management must be designed with preserving life as a priority, recognizing the additional risk factor of inhalation injury as well as the traditional predictors of mortality--age and proportion of the TBSA burned. The aim of care in dorsal hand burns is to restore wound coverage and movement within 14 days of injury. Determining the depth of thermal injury to the upper extremity is notoriously difficult and requires serial assessment over time to most accurately predict the time of healing, still considered the standard measure of burn depth despite newly developing technical assessment tools. Tangential excision and split-thickness autograft coverage are predictably uniformly successful for deep dermal burns in restoring function in both the short and long term; however, burns exposing underlying tendons, bones, or joints require individualized reconstructive procedures, including local and distant flaps, free-tissue transfers, or combinations of these procedures. Early TAM is the most successful modality for recovery of function and to minimize any one of many potential complications associated most commonly with deep wounds and prolonged periods of healing.