Successful treatment of hand burns requires a balance between providing reliable soft tissue coverage and maximizing long-term maintenance of intrinsic function.  Débridement of hand burns is complicated by the absence of thick subcutaneous and muscular layers protecting underlying vital structures. Timing of débridement and choice of reconstructive method is guided by reducing unnecessary excision while maximizing the area of viable tissue.  We present a case of successful treatment of deep partial-thickness hand burns using precision hydrosurgical tangential excision prior to split-thickness skin grafting. 

            The patient is a 54-year-old, right-hand-dominant male, who presented to our trauma center with a 4% TBSA deep partial-thickness burn on the dorsum of his right hand.  We initiated intensive hand therapy on post-burn day one and continued Silvadene dressing changes while allowing the burns to demarcate.  On post-burn day five, we tangentially excised the burns using the Versajet Hyrodsurgery System (Figure 1)  In so doing, we were able to quickly débride layer by layer to viable tissue.  Split-thickness sheet grafting was then performed and achieved 100% take.  The patient continues to follow in our clinic with an excellent functional and aesthetic outcome.

Figure 1.