Thermal injury to the upper extremity and hands remains a common clinical event. The severity of injury ranges from mild to catastrophic, and recovery from burn injuries must take into consideration functional as well as aesthetic outcomes. The cornerstones of upper extremity burn care are early excision and stable soft tissue coverage, splinting, early mobilization, and concerted rehabilitation.

The upper extremity is involved in 89% of burns, with 1% of the population of Western countries sustaining a burn injury each year. One fourth of these patients will require medical care.

The dorsum of the hand is more likely to be involved in explosive or flame injuries while the palmar surface is more likely to be involved in friction burns and electrical injuries. The location of the burn wound is significant in the severity of the injury. The thin and mobile skin on the dorsum of the hand facilitates direct thermal effects on the tendons, blood vessels, and joints directly below the surface. The glabrous skin on the palmar surface of the hand has a thick epidermis and subcutaneous fat layer with a dense arrangement of fibrous septa connecting to the deep fascia to provide shock absorption and frictional stability.

The evaluation of thermal injuries is based on the extent and severity of soft tissue injury. The extent of the injury may not be clear early as it is often difficult to determine the depth of the burn. All burned patients must be fully evaluated for concomitant systemic injuries and aggressively resuscitated. Referral to a specialized burn center has been well defined by the American Burn Association.