{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:07:14Z","timestamp":1790741234074,"version":"4.1.0"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,5,5]],"date-time":"2024-05-05T00:00:00Z","timestamp":1714867200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EBJ"],"abstract":"<jats:p>Burns are inevitable in modern warfare and have comprised between 5% and 20% of battlefield injuries. Involvement of the hands is the leading cause of postburn functional impairment. The purpose of this paper is to provide guidance on aspects of care necessary for the management of complex hand burns in a battlefield setting. Proper assessment and establishment of a comprehensive plan of care at the onset of injury help to ensure optimal functional outcomes in hand function. Basic treatment principles for the acutely burned hand include edema management; early wound coverage, including excision of the burn and skin grafting; early and aggressive hand therapy; and burn-scar contracture mitigation strategies.<\/jats:p>","DOI":"10.3390\/ebj5020011","type":"journal-article","created":{"date-parts":[[2024,5,6]],"date-time":"2024-05-06T15:09:36Z","timestamp":1715008176000},"page":"126-144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Acute Surgical and Rehabilitation Management of Complex Hand Burns in Combat Casualties"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5890-3048","authenticated-orcid":false,"given":"Jill M.","family":"Cancio","sequence":"first","affiliation":[{"name":"U.S. Army Institute of Surgical Research Burn Center, 3698 Chambers Pass, JBSA, Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan B.","family":"Lundy","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research Burn Center, 3698 Chambers Pass, JBSA, Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leopoldo C.","family":"Cancio","sequence":"additional","affiliation":[{"name":"U.S. Army Institute of Surgical Research Burn Center, 3698 Chambers Pass, JBSA, Fort Sam Houston, TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/S0140-6736(00)43153-3","article-title":"Restoration of function in the burnt hand","volume":"241","author":"Bodenham","year":"1943","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1097\/01.BCR.0000155540.31879.FB","article-title":"Burn support for Operation Iraqi Freedom and related operations, 2003 to 2004","volume":"26","author":"Cancio","year":"2005","journal-title":"J. Burn Care Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1007\/s40719-022-00232-6","article-title":"Burn Injuries from a military perspective","volume":"8","author":"Gurney","year":"2022","journal-title":"Curr. Trauma. Rep."},{"key":"ref_4","first-page":"S207","article-title":"Burns: Military options and tactical solutions","volume":"54","author":"Thomas","year":"2003","journal-title":"J. Trauma."},{"key":"ref_5","first-page":"37","article-title":"Burn Care During Operation Desert Storm","volume":"PB 8-92-1\/2","author":"Becker","year":"1992","journal-title":"J. US Army Med. Dep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.burns.2006.03.008","article-title":"Burns sustained in combat explosions in Operations Iraqi and Enduring Freedom (OIF\/OEF explosion burns)","volume":"32","author":"Kauvar","year":"2006","journal-title":"Burns"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.burns.2022.03.011","article-title":"Galarneau, Burn injuries in US service members: 2001\u20132018","volume":"49","author":"Perez","year":"2023","journal-title":"Burns"},{"key":"ref_8","first-page":"19","article-title":"Global evacuation of burn patients does not increase the incidence of venous thromboembolic complications","volume":"65","author":"Chung","year":"2008","journal-title":"J. Trauma."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1053\/j.jfas.2005.02.007","article-title":"Operation Iraqi Freedom: The Landstuhl Regional Medical Center experience","volume":"44","author":"Johnson","year":"2005","journal-title":"J. Foot Ankle Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.7205\/MILMED.172.11.1148","article-title":"Wartime burn care in Iraq: 28th Combat Support Hospital, 2003","volume":"172","author":"Stout","year":"2007","journal-title":"Mil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1093\/milmed\/155.3.130","article-title":"Burns in the Lebanon War 1982: \u201cThe blow and the cure\u201d","volume":"155","author":"Eldad","year":"1990","journal-title":"Mil. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1097\/00006534-199711000-00010","article-title":"Prospective outcome analysis of a protocol for the surgical and rehabilitative management of burns to the hands","volume":"100","author":"Barillo","year":"1997","journal-title":"Plas Reconstr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0305-4179(99)00067-4","article-title":"The prognostic factors regarding long-term functional outcome of full-thickness hand burns","volume":"25","author":"Kreis","year":"1999","journal-title":"Burns"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.injury.2013.01.015","article-title":"Rehabilitation of hand burn injuries: Current updates","volume":"44","author":"Cowan","year":"2013","journal-title":"Injury"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1097\/BCR.0B013E318093E4B9","article-title":"Hand burns","volume":"28","author":"Kowalske","year":"2007","journal-title":"J. Burn. Care Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1016\/j.jhsa.2015.02.033","article-title":"Management of the Acutely Burned Hand","volume":"40","author":"Pan","year":"2015","journal-title":"J. Hand Surg. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/SAP.0000000000002755","article-title":"Acute Management of Thermal Hand Burns in Adults: A 10-Year Review of the Literature","volume":"86","author":"Dargan","year":"2021","journal-title":"Ann. Plast. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"C41","DOI":"10.12968\/hmed.2016.77.3.C41","article-title":"Assessment of hand injuries","volume":"77","author":"Wong","year":"2016","journal-title":"Br. J. Hosp. Med."},{"key":"ref_19","unstructured":"Herndon, D. (2018). Total Burn Care, Elsevier, Inc."},{"key":"ref_20","first-page":"207","article-title":"The burn edema process: Current concepts","volume":"26","author":"Demling","year":"2005","journal-title":"J. Burn. Care Rehabil."},{"key":"ref_21","unstructured":"Herdon, D.N. (2002). Total Burn Care, WB Saunders."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1097\/BCR.0b013e31802c9eb9","article-title":"The reliability and concurrent validity of the figure-of-eight method of measuring hand edema in patients with burns","volume":"28","author":"Dewey","year":"2007","journal-title":"J. Burn. Care Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00000658-197704000-00003","article-title":"Sequential circulatory changes in the circumferentially burned limb","volume":"185","author":"Clayton","year":"1977","journal-title":"Ann. Surg."},{"key":"ref_24","first-page":"263","article-title":"Surgical Escharotomy and Decompressive Therapies in Burns","volume":"41","author":"Butts","year":"2020","journal-title":"J. Burn. Care Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.jhsa.2010.10.021","article-title":"Reconstructive options of burn injuries to the hand and upper extremity","volume":"36","author":"McKee","year":"2011","journal-title":"J. Hand Surg. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1097\/00006534-197610000-00008","article-title":"Evaluation of digital escharotomy in burned hands","volume":"58","author":"Salisbury","year":"1976","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_27","unstructured":"Cubano, M.A. (2018). Emergency War Surgery, 5th US Revision."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.bjps.2021.09.074","article-title":"Evaluation of burned hand function after enzymatic debridement","volume":"75","year":"2022","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/00004630-200111000-00007","article-title":"Prospective trial of thick vs standard split-thickness skin grafts in burns of the hand","volume":"22","author":"Mann","year":"2001","journal-title":"J. Burn. Care Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1007\/s11552-014-9630-1","article-title":"Integra\u00ae dermal regenerative template application on exposed tendon","volume":"9","author":"Hulsen","year":"2014","journal-title":"Hand"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1544","DOI":"10.1016\/j.bjps.2012.05.021","article-title":"Tendon coverage using an artificial skin substitute","volume":"65","author":"Shores","year":"2012","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.burnso.2017.08.001","article-title":"Experience with a synthetic bilayer Biodegradable Temporising Matrix in significant burn injury","volume":"2","author":"Greenwood","year":"2018","journal-title":"Burns Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1016\/j.burns.2021.07.014","article-title":"Wound healing and dermal regeneration in severe burn patients treated with NovoSorb\u00ae Biodegradable Temporising Matrix: A prospective clinical study","volume":"48","author":"Lo","year":"2022","journal-title":"Burns"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1097\/BCR.0b013e3181b48610","article-title":"Full-thickness vs split-skin grafting in pediatric hand burns--a 10-year review of 174 cases","volume":"30","author":"Chandrasegaram","year":"2009","journal-title":"J. Burn. Care Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.jhsa.2016.06.006","article-title":"Defining the Indications of Pedicled Groin and Abdominal Flaps in Hand Reconstruction in the Current Microsurgery Era","volume":"41","year":"2016","journal-title":"J. Hand Surg. Am."},{"key":"ref_36","first-page":"51","article-title":"Extremity soft tissue coverage in the combat zone: Use of pedicled flap transfers by the deployed orthopedic surgeon","volume":"7","author":"Mathieu","year":"2020","journal-title":"Mil. Med. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/j.jhsa.2011.01.046","article-title":"Interphalangeal joint K-wiring: A useful adjunct in the acute management of burn injuries to the hand and upper extremity","volume":"36","author":"Gurusinghe","year":"2011","journal-title":"J. Hand Surg. Am."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1097\/00006534-198412000-00012","article-title":"The use of a buried wire frame to reduce contracture of grafts","volume":"74","author":"Planas","year":"1984","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_39","unstructured":"Spence, R. Personal Communication."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/S0002-9610(66)90762-8","article-title":"Burned hands in children","volume":"112","author":"Smith","year":"1966","journal-title":"Am. J. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/01.sap.0000192029.78667.c6","article-title":"Kirschner-wire fixation for postburn flexion contracture deformity and consequences on articular surface","volume":"56","author":"Sungur","year":"2006","journal-title":"Ann. Plast. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1097\/BCR.0b013e3181ac016c","article-title":"Blackbourne, Identification of cutaneous functional units related to burn scar contracture development","volume":"30","author":"Richard","year":"2009","journal-title":"J. Burn. Care Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1097\/BCR.0b013e318220c15a","article-title":"Clinical competencies for burn rehabilitation therapists","volume":"32","author":"Parry","year":"2011","journal-title":"J. Burn. Care Res."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1097\/BCR.0b013e318171081d","article-title":"A clarion to recommit and reaffirm burn rehabilitation","volume":"29","author":"Richard","year":"2008","journal-title":"J. Burn. Care Res."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1093\/jbcr\/iraa104","article-title":"Randomized controlled trial of compression interventions for managing hand burn edema, as measured by bioimpedance spectroscopy","volume":"41","author":"Edwick","year":"2020","journal-title":"J. Burn. Care Res."},{"key":"ref_46","first-page":"4","article-title":"Management of burns to the hand","volume":"15","author":"Barillo","year":"2003","journal-title":"Wounds"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.pmr.2011.02.001","article-title":"Positioning, splinting, and contracture management","volume":"22","author":"Dewey","year":"2011","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Pasquina, P., and Cooper, R. (2009). Rehabilitation of burn casulaties, Textbooks in Military Medicine: Care of the Combat Amputee.","DOI":"10.1037\/e628382011-001"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1097\/BCR.0b013e31817db8e1","article-title":"Contractures in burn injury part II: Investigating joints of the hand","volume":"29","author":"Schneider","year":"2008","journal-title":"J. Burn. Care Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e960","DOI":"10.1097\/BCR.0000000000000529","article-title":"Burn hand or finger goniometric measurements: Sum of the isolated parts and the composite whole","volume":"38","author":"Richard","year":"2017","journal-title":"J. Burn. Care Res."},{"key":"ref_51","unstructured":"Skirven, T.M., Osterman, A.L., Fedorczyk, J., and Amadio, P.C. (2021). Rehabilitation of the Hand and Upper Extremity, Elsevier, Inc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.burns.2016.08.003","article-title":"Burn-related peripheral neuropathy: A systematic review","volume":"43","author":"Tu","year":"2017","journal-title":"Burns"},{"key":"ref_53","first-page":"483","article-title":"Critical care rehabilitation of the burn patient","volume":"103","author":"Cancio","year":"2023","journal-title":"Surg. Clin."}],"container-title":["European Burn Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-1991\/5\/2\/11\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:40:02Z","timestamp":1760107202000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-1991\/5\/2\/11"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,5]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["ebj5020011"],"URL":"https:\/\/doi.org\/10.3390\/ebj5020011","relation":{},"ISSN":["2673-1991"],"issn-type":[{"value":"2673-1991","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,5]]}}}