Tangential excision of eschar for deep burns of the hand: analysis of 156 patients collected over 10 years.

Deep burns affecting the dorsum of the hand have been treated by tangential excision of the eschar in 156 patients involving 208 hands. From our 10-year experience we have concluded that: If the patient's general condition permits it all hands with deep partial and full thickness skin loss burns are suitable for early tangential excision of the eschar. The best time for the operation is within the first week after injury. If the burn is of limited extent and the requirement for autograft skin is small the operation may be carried out under nerve block anaesthesia. When the burn is more extensive (i.e. involving both hands) intravenous ketamine anaesthesia is recommended. During tangential excision sequential layers of tissue must be removed until the base of the burn appears porcelain white in colour, has a lustrous appearance with many small bleeding points and is firm in consistency. If there are deep burns of the finger webs they are incised or excised and then grafted. Postoperatively an absence of fever, pain or exudation from the wound indicates that inspection of the wound can be delayed for about 2 weeks. By this time the wound is usually healed and functional rehabilitation and physiotherapy can commence.