How to Treat a Burn

Burns occur when tissue is damaged by heat, fire, chemicals, electricity, or the sun. Since we use our hands to interact with the world, burns to the hand are some of the most common burn injuries.

Figure 1

Layers of skin

Figure 2

Degrees of burn injury

Figure 3

Splint used until the graft is healed

Causes

Many things can cause a burn injury:

Heat: Burn injuries from heat can occur from a stovetop, hot pavement during the summer, spilled hot liquids, or steam.
Fire: When skin is exposed to flame, burns can occur. Common causes of fire burns include grilling (learn more about grilling safety), fireworks (learn more about fireworks safety), or campfires. House fires or automobile accidents can also cause flame burns.
Chemicals: Certain chemicals are dangerous if they come in contact with skin. Chemical burns are caused by damage to the tissues from chemical exposure.
Electricity: Electrical burns can occur from touching damaged electrical cords or outlets, working with certain machinery or tools, or from lightning. Electrical burns often cause a small area of visibly burned skin but can cause deeper damage as the electricity travels through the body.
Sun: Exposure to sunlight is a type of radiation, which can cause burns to the skin. Depending on the intensity and duration of sun exposure, sunburn can cause mild or severe injury.

Signs and Symptoms

Burn symptoms vary based on the type and severity of the burn. Burn symptoms can include:

Color change: Burned skin can be pink, red, white, tan, or black.
Blisters: Deeper burns can cause blistering. Blisters occur when the layers of the skin separate and fluid collects between the layers.
Peeling: Some burns cause damage to the top layers of skin, causing them to peel.
Swelling: Burns cause swelling in the area of the burn and the tissue around it. This can feel like tightness in the hand or fingers and can cause difficulty moving the joints in the hand or fingers.
Pain: Burns are usually painful when they first occur and become less painful as they heal. Very deep burns that damage the sensory part of the skin can become painless, but this is due to severe damage.

Depending on the injury, burns may not look severe at first but can worsen over the next few hours or days. In other situations, the burn symptoms can be most severe on the day of injury and get better over time.

Diagnosis

Burn injuries are diagnosed based on examination by a medical professional. Burns to the hand or upper extremity may require evaluation and treatment by a physician who specializes in injuries to the hand or upper extremity.

Burns are treated differently based on the severity and depth of injury. The severity of the injury depends on the intensity of the heat or chemical and the length of time it is in contact with the skin.

Your doctor will classify your burn based on depth. This is commonly referred to as the “degree” of your burn (Figures 1 and 2).

1st Degree: Superficial partial thickness. This means only the top layer of the skin is involved. These burns usually look red without blisters or peeling.
2nd Degree: Deep partial thickness. This means the burn damage is affecting the deeper layers of the skin, but not all layers. These burns usually look red, pink, or white with blisters and/or peeling.
3rd Degree: Full thickness. These burns have affected all layers of the skin. These burns look white or tan and feel leathery to the touch.
4th Degree: Deep structure damage. These burns not only affect the skin but also cause damage to the deeper structures such as tendons, muscles, joints, or bones.

Your doctor will also calculate the amount of your body that has been burned. This is measured as a percentage of the total skin surface of your body. In general, the amount of space taken up by your handprint represents 1% of your body’s skin surface.

Treatment

Initial first aid measures include removing the hand from the source of the burn and cleaning it. Pain control is also an important part of the initial treatment of burns and may include cooling the burned area or giving medications to control pain.

Deep burns or burns over a major percentage of the body may require hospitalization. This may require treatment at a hospital that specializes in burn care. Burns that are less severe or occur over a more limited area may be treated with clinic visits rather than hospitalization.

Further burn treatment depends on the cause and severity of the injury. These treatments are focused on removing any dead tissue, preventing infection, and preventing stiffness.

1st Degree (Superficial Partial Thickness)

Wound care: These burns need to be kept clean with good hand washing. Your doctor may recommend an ointment or other dressing.
Recovery: Superficial partial-thickness burns usually heal within a few days or weeks.

2nd Degree (Deep Partial Thickness)

Woundcare: These burns need to be kept clean. Follow instructions given by your doctor on how to clean these wounds. Blisters on the hand may or may not be trimmed. Open areas may be treated with ointments or bandages until the wounds are healed.
Splinting and therapy: Healing deeper burns can cause the skin to contract, which can cause stiffness in the joints of the hand or fingers if they are not held in a good position during healing. Your doctor or therapist may recommend you wear a splint during healing to prevent stiffness (Figure 3). Therapy may be recommended during or after healing to improve hand function.
Recovery: Deep partial-thickness burns usually heal within 2-8 weeks.

3rd and 4th Degree (Full Thickness and Deep Structure Damage)

Surgery: Full-thickness burns mean that all layers of the skin have been damaged. The dead skin will need to be removed to prevent infection. That skin will then need to be replaced. Burned skin can be replaced in several ways, depending on the area and extent of the burn:
- Skin graft: A skin graft is a surgery in which normal skin is taken from another area of the body to replace the burned skin. The replacement skin can be taken from different areas of the body, depending on what is needed.
- Wound matrix: This is a surgery in which a product called wound matrix is applied to the burned area. There are several kinds of wound matrices, but all of these are products that come out of a package. Sometimes, wound matrix application is the only surgery required to treat a burn. Other times, the wound matrix is applied in the first surgery, and after it has healed (usually 2-3 weeks), a skin graft is placed on top of the wound matrix in a second surgery.
- Flap surgery: If a burn wound is deeper, more complex, or causes exposure of structures like tendons or bone, flap surgery may be required. This is a surgery in which tissue (called a “flap”) is taken from another area of the body, either nearby or far away, to replace the burned tissue. Flaps are different than skin grafts because they include multiple layers of tissue, such as skin, fat, and/or muscle, and they have their own artery and vein to provide nutrition to the transferred tissue.
Wound care: Before and after surgery, deep burns will need to be kept clean to prevent infection. Wound care will depend on the type of surgery performed and can include ointments and bandages or the use of a device called a wound VAC. A wound VAC provides suction over an area to help prepare it for surgery or to help a skin graft stick down in a new location.
Splinting and therapy: Healing of deep burns or skin grafts can cause the skin to contract, which can cause stiffness in the joints of the hand or fingers if they are not held in a good position during healing. Your doctor or therapist will recommend you wear a splint during healing to prevent stiffness (Figure 3). Therapy may be recommended during or after healing to improve hand function.
Recovery: Full-thickness burns typically take weeks to months to heal. These burns may require multiple procedures over several years to achieve optimal healing and function.

Many patients with severe burn injuries will require more than one operation. Burned hands may also develop contractures over time, sometimes months or years after the original injury. Contractures are scars of the skin that limit joint movement, causing stiffness or constricted motion. Patients who sustain severe burns or burns over a joint surface require long-term follow-up with a hand surgeon. At these appointments, your surgeon will examine you to see if there is any additional treatment that could improve your hand function.

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.

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