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The timing of surgery for deep burns of the hands: Early versus delayed surgery
burns 33 (2007) 807
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
The timing of surgery for deep burns of the hands: Early versus delayed surgery Burns to the hand can be devastating and the treatment of the burned hand should therefore be of interest for all who treat those wounds. Surgical excision and the application of autologous split thickness skin grafts is mainstay for the treatment of deep hand burns. Generally hands are treated and operated in the early phase after wounding. However, timing of the surgery is still under debate and scientific support for these expert opinions are sparse. We therefore appreciate the work of Tambuscio et al. that was recently published in this journal [1]. The authors come to the conclusion that burned hands should be operated in the early phase in order to achieve the best results and reducing re-admissions for secondary revisions. However, we feel that these conclusions warrant further discussion. The group that was operated early was different from the secondarily treated group by selection criteria. Because the surgical strategy was dictated by patient’s general conditions and overall extent of burn it can be assumed that secondarily treated group contained more severely burned hands. This may, at least partly, explain the poor result in this group. It is therefore useful to be informed on the extent of the hand burns and the frequency of finger amputations in both groups. In the discussion section the authors refer to a study from our burn centre [2]. The conclusions of their study contrast the results of our study. They felt that the difference in outcome was the result of a different evaluation protocol. However, we feel that the differences in study outcome may be related to the differences in data analysis. In our study, a logistic regression model was used that allowed us to compensate for depth and extension of the hand burn, TBSA, age, amputations and need for reconstructive surgery. Our data and subsequent logistic regression analysis revealed no significant influence of the timing of surgery. It should be noted that our conclusions are in line with prospective studies that have been published on this subject and that failed to demonstrate conclusive evidence for the
early surgical approach towards hand burns [3–5]. More randomized controlled trials will hopefully provide increasing evidence on this matter.
references
[1] Tambuscio A, Governa M, Caputo G, Barisoni D. Deep burn of the hands: early surgical treatment avoids the need for late revisions? Burns 2006;32(8):1000–4. [2] van Zuijlen PP, Kreis RW, Vloemans AF, Groenevelt F, Mackie DP. The prognostic factors regarding long-term functional outcome of full-thickness hand burns. Burns 1999;25(8): 709–14. [3] Goodwin CW, Maguire MS, McManus WF, Pruitt BA. Prospective study of burn wound excision of the hands. J Trauma 1983;23(6):510–7. [4] Salisbury RE, Wright P. Evaluation of early excision of dorsal burns of the hand. Plast Reconstr Surg 1982;69(4):670–5. [5] Edstrom LE, Robson MC, Macchiaverna JR, Scala AD. Prospective randomized treatments for burned hands: nonoperative vs. operative. Preliminary report. Scand J Plast Reconstr Surg 1979;13(1):131–5.
P.P.M. van Zuijlen* A.F.P.M. Vloemans F.R.H. Tempelman R.W. Kreis Red Cross Hospital, Burn Center, Department of Plastic, Reconstructive and Hand Surgery, Vondellaan 13, 1942 LE Beverwijk, The Netherlands *Corresponding author. Tel.: +31 251 265 555 E-mail address: [email protected] 0305-4179/$32.00 # 2007 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.02.001
available at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
The timing of surgery for deep burns of the hands: Early versus delayed surgery Burns to the hand can be devastating and the treatment of the burned hand should therefore be of interest for all who treat those wounds. Surgical excision and the application of autologous split thickness skin grafts is mainstay for the treatment of deep hand burns. Generally hands are treated and operated in the early phase after wounding. However, timing of the surgery is still under debate and scientific support for these expert opinions are sparse. We therefore appreciate the work of Tambuscio et al. that was recently published in this journal [1]. The authors come to the conclusion that burned hands should be operated in the early phase in order to achieve the best results and reducing re-admissions for secondary revisions. However, we feel that these conclusions warrant further discussion. The group that was operated early was different from the secondarily treated group by selection criteria. Because the surgical strategy was dictated by patient’s general conditions and overall extent of burn it can be assumed that secondarily treated group contained more severely burned hands. This may, at least partly, explain the poor result in this group. It is therefore useful to be informed on the extent of the hand burns and the frequency of finger amputations in both groups. In the discussion section the authors refer to a study from our burn centre [2]. The conclusions of their study contrast the results of our study. They felt that the difference in outcome was the result of a different evaluation protocol. However, we feel that the differences in study outcome may be related to the differences in data analysis. In our study, a logistic regression model was used that allowed us to compensate for depth and extension of the hand burn, TBSA, age, amputations and need for reconstructive surgery. Our data and subsequent logistic regression analysis revealed no significant influence of the timing of surgery. It should be noted that our conclusions are in line with prospective studies that have been published on this subject and that failed to demonstrate conclusive evidence for the
early surgical approach towards hand burns [3–5]. More randomized controlled trials will hopefully provide increasing evidence on this matter.
references
[1] Tambuscio A, Governa M, Caputo G, Barisoni D. Deep burn of the hands: early surgical treatment avoids the need for late revisions? Burns 2006;32(8):1000–4. [2] van Zuijlen PP, Kreis RW, Vloemans AF, Groenevelt F, Mackie DP. The prognostic factors regarding long-term functional outcome of full-thickness hand burns. Burns 1999;25(8): 709–14. [3] Goodwin CW, Maguire MS, McManus WF, Pruitt BA. Prospective study of burn wound excision of the hands. J Trauma 1983;23(6):510–7. [4] Salisbury RE, Wright P. Evaluation of early excision of dorsal burns of the hand. Plast Reconstr Surg 1982;69(4):670–5. [5] Edstrom LE, Robson MC, Macchiaverna JR, Scala AD. Prospective randomized treatments for burned hands: nonoperative vs. operative. Preliminary report. Scand J Plast Reconstr Surg 1979;13(1):131–5.
P.P.M. van Zuijlen* A.F.P.M. Vloemans F.R.H. Tempelman R.W. Kreis Red Cross Hospital, Burn Center, Department of Plastic, Reconstructive and Hand Surgery, Vondellaan 13, 1942 LE Beverwijk, The Netherlands *Corresponding author. Tel.: +31 251 265 555 E-mail address: [email protected] 0305-4179/$32.00 # 2007 Elsevier Ltd and ISBI. All rights reserved. doi:10.1016/j.burns.2007.02.001