Delayed definitive reconstruction of the burned hand: evolution of a program of care.

Experience gained in treating patients with hand burns admitted to an active Regional Burn Center has resulted in the development of a biphasic approach which separates early healing and later reconstructive surgical procedures. This schedule permits late definitive surgery on healed functioning hands and is accomplished in a single operation in most cases. This biphasic approach has led to better results at our institution in terms of hand function and appearance, and to a decrease in total numbers of surgical procedures. Reports of others using alternative methods and schedules, also with satisfactory results, are discussed.