Physical and quality of life outcomes of patients with isolated hand burns--a prospective audit.

Hand burns can have major implications on function, appearance, and quality of life. Our clinical practice has changed over the last 10 years, with a steady increase in the proportion of hand burns receiving early and aggressive surgical management using Biobrane® sheets/gloves and a concomitant fall in the proportion requiring excision and split skin grafting. The aim of this study was to measure a comprehensive range of outcomes for patients admitted with isolated hand burns to review our outcomes and provide us with the "expected" patterns of recovery. A prospective audit was performed over a 14-month period, with outcomes measured during hospital admission and at 2 weeks, 1, 3, 6, and 12 months postinjury (depending on the method of management). Outcomes comprised pain, the Burns Specific Health Scale (abbreviated version B), return to work/leisure, total active range of motion, grip strength, the Michigan Hand Questionnaire, and scar appearance using Matching Assessment with Photographs of Scars. A total of 52 patients (35 male, mean age 39 years) with 57 burned hands participated. Patients whose burn injuries were such that they were able to be managed conservatively or with Biobrane® showed rapid recovery in all outcomes, with normal or near-normal values achieved within 2 weeks to 1 month postinjury. The patients whose burn injuries required excision and split skin grafting demonstrated more marked initial deterioration, a slower rate of improvement, but eventual good recovery. In conclusion, for this sample of patients with isolated hand burns, recovery was good and rapid for those whose burn injuries were such that they were managed conservatively or with Biobrane®.

Reliability testing of a new scar assessment tool, Matching Assessment of Scars and Photographs (MAPS).

A new scar-assessment tool, the Matching Assessment of Scars and Photographs (MAPS), which uses a set of reference photographs, a numeric scale, and location technique, was tested for its reliability in two stages. First, using five adults, three raters assessed 32 burns scars twice within 3 days. Subsequently, reliability was tested during a 6-month time frame, emphasizing the process of localizing test areas as scars changed and raters forgot the previous assessment. Three raters, from a pool of five, each made three assessments on 29 scars in seven subjects, on average 8 weeks apart. Inter-rater reliability was tested, using Kendall's Tau C and intraclass correlations, respectively, for stages 1 and 2. Agreement was good for border height (0.63-0.70 and 0.78), moderate to good for thickness (0.60-0.74 and 0.81), and good for color (0.55-0.71 and 0.79), whereas for surface it was fair (0.25-0.38 and 0.40). The localization technique was reliable (accuracy within 3 mm) in 93% to 96% of recordings. The MAPS tool is considered ready for clinical use.