Functional outcome of the burned hand after skin grafting.

Rationale:
The hand is one of the most frequent burned body parts. In severely burned hands, surgical wound care is often necessary. A split skin graft is used to cover the wound. Contraction of the skin graft often results in a shortened skin and in the impossibility to make a fist. Burm et al explored the effects of a technique in which hands are grafted in a fist position, with all fingers flexed in a grip position and a flexed wrist. They observed good functional and cosmetic results. However, no quantitative data were reported.


Objective:
1. To assess the feasibility of a new treatment protocol of skin grafting of the burned dorsal hand in fist position with wrist in 30° flexion per and post ok;

2. To explore the effects of skin grafting on the burned dorsal hand in fist position with wrist in 30° flexion, on range of motion, hand function, muscle strength and oedema.


Study design:
A randomised controlled intervention study.
Study population: Patients with burned dorsal hand requiring skin grafting of the dorsal hand and finger(s). A total of 12 hands will be included.


Intervention:
In the index group, the hand will be grafted in a fist position, with all fingers in a fist position and the wrist in 30° flexion. In the comparator group, hand will be grafted in the standard neutral position of wrist and fingers (usual care). In both groups, hands will be fixed 5 days post ok in their position.


Main study parameters/endpoints:
The main study parameter is the difference in time to complete active full fist position between the index and comparator group. Secondary outcome assessment include active and passive joint range of motion, observed and self-reported hand function, muscle strength and oedema. Outcome assessors will evaluate functional outcome 7 and 14 days post ok and at 1, 5 and 12 months post ok. Feasibility will be assessed by evaluation of patient inclusion and drop-out and the burden for patients and staff.

The hand is one of the most frequent burned body parts. In severely burned hands, surgical wound care is often necessary. A split skin graft is used to cover the wound. Contraction of the skin graft often results in a shortened skin and in the impossibility to make a fist. Burm et al explored the effects of a technique in which hands are grafted in a fist position, with all fingers flexed in a grip position and a flexed wrist. They observed good functional and cosmetic results. However, no quantitative data were reported.

Hand burns which are grafted in a fist position, with all fingers flexed in a grip position and a flexed wrist have an improved fucntional outcome .

Outcome assessors will evaluate functional outcome 7 and 14 days post ok and at 1, 5 and 12 months post ok.

In the index group, the hand will be grafted in a fist position, with all fingers in a fist position and the wrist in 30° flexion. Hands will be fixed 5 days post ok in this position.


In the comparator group, hand will be grafted in the standard neutral position of wrist and fingers (usual care). Hands will be fixed 5 days post ok in this position.