S. Shockey1, H. Y. Liu1, M. Alessandri Bonetti1, J. A. Ziembicki2, G. M. Stofman1, F. M. Egro1,2 1University of Pittsburgh Medical Center, Department Of Plastic Surgery, Pittsburgh, PA, USA 2University of Pittsburgh Medical Center, Department Of Surgery, Pittsburgh, PA, USA
Introduction:
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 for hand burn management and the role of dermal substitutes in treatment.
Methods:
A cross-sectional study was conducted in December 2022. A 9-question survey related to acute hand burns management was sent to 64 directors of American Burn Association (ABA)-verified burn centers.
Results:
10 respondents reported their standard of care for acute hand burns. Hand burns are managed in 70% (n = 7) of burn centers by burn surgeons only, 20% by either burn or plastic surgeons (n = 2), and 10% by plastic surgeons only (n = 1). For the treatment of superficial partial-thickness hand burns, directors preferred a non-operative approach (n = 9; 90%) or single-stage reconstruction involving excision and skin grafting (n = 1; 10%). Most respondents chose single-stage excision and skin graft for deep partial-thickness hand burns (n = 8; 80%) and full-thickness hand burns (n = 7; 70%). However, some preferred a two- or three-stage reconstruction with allograft, xenograft, or skin substitute. Among 6 respondents who use dermal templates, Novosorb-BTM (n = 2; 33.3%) and Integra (n = 2; 33.3%) were preferred. The top clinical reasoning for choosing one specific dermal substitute was the surgeon's preference (n = 6; 60%) and cost (n = 4; 40%).
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.