Early experience with tangential excision and skin grafting of deep dermal burns of the hand among diabetics and nondiabetics

Abstract

Introduction: Deep dermal injury of the hand should have a special management because it has a high potential to affect the functional capabilities of the hand. This study was established to measure the outcome of managing these special types of patients and comparing their outcome with nondiabetics. The goal was to intervene and cover the wound within a time limit of <14 days. Patients and Methods: Between the period of November 2011 and October 2013, we managed a total number of 12 patients with deep dermal burn to the hands in the Burn Unit at King Fahad General Hospital, Jeddah . Four patients were insulin-dependent diabetics, and eight were nondiabetics. An early tangential excision and skin grafting was done in these patients within 14 days of injury. Results: All 12 patients were male. The average age was 45 years. The average total body surface area (TBSA) burnt was 35%, with a range of 2-65%. Four patients were insulin-dependent diabetics, whereas eight patients had no medical comorbidity. Two of the diabetics had an isolated hand burn, and the other two had 30% and 50% of TBSA full-thickness burn, respectively. The graft take was satisfactory among the patients with no difference between the diabetics and the nondiabetics. The grafted hands underwent physiotherapy following the procedure. Satisfactory outcomes were seen among all the grafted hands, with near return to full function. Conclusions: Tangential excision is recommended during the first 5 days postburn to reduce the risk of infection and graft loss. Diabetic patients do not behave differently from nondiabetic patients in their response to graft take, wound healing, and return to work.