When considering extensive burn scarring restricting movement of all joints of both upper limbs, which should be the order of priority for surgical release?
A. The dominant hand should be treated firstThe axilla of the dominant hand should be treated first. The hand is unable to function without restoration first of proximal mobility, and the dominant limb is a priority. There is no point in performing complicated reconstructive surgery in the hand of an immobile upper limb. The principle is to work from trunk to extremity and in the upper limb consider the sequential release of axilla, elbow, wrist then hand and prioritizing the side that will give the dominant hand optimum function.
References:
1. Young RC, Burd A. Paediatric upper limb contracture release following burn injury. Burns 2004; 30(7): 723-8.