Experience with upper extremity burns. The Mount Vernon experience.

History and clinical examination remain the mainstay in assessing burn depth. There is no satisfactory objective test for burn depth. Silicone oil in loose bags is the dressing of choice for the conservative management of superficial burns. Deep dermal burns of the dorsum of the hand should be shaved and grafted within the first 5 days. Full-thickness burns of the dorsum without exposure of deep structures should be excised and grafted within the first 5 days. K-wires may be used to stabilize metacarpophalangeal and PIP joints to prevent secondary deformity while grafts heal, but should not be left longer than 6 weeks. Flaps used to repair full-thickness burns with exposure of deep structures should be planned to permit elevation and movement. Primary reconstruction of extensor mechanisms should be performed at the time of flap cover.