Full thickness, circumferential burns of the hands require escharotomy. Digital escharotomies are performed along the mid-lateral lines and usually one suffices. The side of the escharotomy avoids the functional surfaces:
It may be necessary to release the thenar and hypothenar muscle groups, often in continuity with more proximal longitudinal incisions.
If there is evidence of interosseous muscle ischaemia, it may be necessary to do a dorsal escharotomy, with or without fasciotomy, through incisions between the metacarpals.
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