Background Deep dermal burns remain a therapeutic challenge, requiring treatment strategies that promote healing while minimizing surgical burden and scarring. Synthetic dermal substitutes based on polylactide terpolymers may offer a promising option for managing deep dermal burns. This study evaluated the clinical value of a polylactic acid (PLA)-based matrix (SupraSDRM®, PolyMedics Innovations GmbH) in deep dermal burns using objective perfusion assessment with Laser Doppler Imaging (LDI). Methods An analysis was performed in 10 consecutive patients with acute thermal burns treated with PLA. Burn depth was assessed preoperatively using LDI. Demographic and burn-related data, timing of matrix application, pain intensity (Numeric Rating Scale, NRS), need for secondary split-thickness skin grafting, length of stay, and scar quality (Vancouver Scar Scale, VSS) were analyzed. Results Mean patient age was 42.3 years (range 16–66) and mean TBSA was 7.5% (range 0.3–18%). The matrix was applied on mean post-burn day 4. Pain intensity decreased significantly from a mean NRS of 5.8 before intervention to 1.8 at 24 h after application (p = 0.002). Mean hospital stay after matrix application was 6 days. Definitive wound healing without grafting was achieved in 8/10 patients. Two patients (6 and 7) required secondary grafting after wound infection that developed following matrix application. At follow-up, scar quality was favorable (mean VSS: 3.3). Scar quality was assessed at the latest available follow-up visit, with a mean follow-up of 12 months (range 8–18). Conclusion Within a perfusion-guided treatment algorithm, lactide-based terpolymer dermal matrices may enable early pain reduction and graft-free wound healing in selected deep dermal burns. When grafting is required, they may still be applied as part of wound bed preparation prior to grafting, supporting their role as a bridge-to-healing strategy.

Background Severe burn injuries remain a significant challenge for healthcare systems despite major advances in treatment. While specialized burn centers play a crucial role in patient care, it remains unclear whether primary admission is associated with better clinical outcomes compared to secondary transfer. This study analyzes the impact of primary versus secondary admission on mortality using data from the German Burn Registry. Methods This study is based on prospectively collected multicenter data from the German Burn Registry. Adult patients requiring specialized burn care according to German S2k guidelines for thermal injury treatment were included. Coarsened Exact Matching (CEM) was used to adjust for baseline differences and ensure comparability between groups. Descriptive statistics and multivariate logistic regression models were applied to assess the association between admission type and mortality. Results Time from injury to admission at the burn center was significantly shorter for primary admissions compared to secondary transfers (108.77 ± 78.21 min vs. 250.43 ± 115.00 min, p < 0.001). In univariate analysis, overall mortality was higher among patients admitted directly (13% vs. 9.9%, p = 0.014), but this effect was no longer significant after adjusting for relevant covariates. Conclusion The results indicate that primary admission to a burn center facilitates faster access to specialized care. The initially observed higher mortality among directly admitted patients may be attributed to a selection bias favoring more severe cases. This study highlights the importance of optimizing referral management to minimize delays in specialized treatment and improve outcomes for burn patients.

Background:Autologous breast reconstruction using the Deep Inferior Epigastric Perforator (DIEP) flap is considered an established standard procedure due to its preservation of the rectus muscles, natural aesthetic results, and high patient satisfaction. At the same time, it is resource-intensive. Case-specific health economic data on cost-effectiveness within the German DRG system have been limited to date. Materials and Methods:A retrospective, single-center case-cost analysis of 18 female patients who underwent unilateral DIEP flap reconstruction in 2023 without perioperative complications or DRG-relevant secondary diagnoses. The study captured directly attributable medical costs for the preoperative, perioperative, and post-hospitalization phases. Revenue analysis was performed using the aG-DRG J01Z, with nursing fees considered separately. In addition, five expert interviews were qualitatively evaluated. Results:The average total direct costs amounted to €9829.07 per patient. The largest share of costs was attributable to the perioperative phase, particularly the surgical phase, which accounted for €5792.27. When considering direct costs, the average DRG revenue of €14,017.05 resulted in a positive contribution margin of €4192.65. Assuming indirect costs of up to 50%, total costs rose to €14,738.94, resulting in a deficit of €721.89 when DRG reimbursement was the sole source of revenue. Only with the additional nursing fee of €1606.85 did a small positive overall balance of €884.97 per case result. Conclusion:Under the conditions described, unilateral DIEP flap surgery may barely break even in the German DRG system, assuming a selected best-case scenario. However, its economic viability remains fragile and is significantly influenced by indirect costs, nursing fees, process standardization, and structural overhead costs. Future reimbursement models should take greater account of process complexity, center structures, and patient-specific long-term outcomes.

Background: Early detection of severe infections in burn patients is difficult due to confounding sterile inflammation. Previous research has shown that Pancreatic Stone Protein (PSP) is less affected by trauma and surgery. Therefore, this study investigated whether longitudinal PSP trends can distinguish sterile post-burn inflammation from clinically relevant infections and indicate response to antimicrobial therapy. Methods: This prospective pilot cohort study included 10 consecutive adult patients with moderate to severe burn injuries admitted to a specialized burn intensive care unit. PSP levels were measured using bedside testing (abioSCOPE®) daily over a 14-day observation period. Clinical parameters, burn severity as assessed by the Abbreviated Burn Severity Index (ABSI), and the occurrence of severe infectious complications, including pneumonia and bacteremia, were systematically recorded. PSP measurements were not used to guide clinical decision-making. Results: Patients who developed severe infectious complications (pneumonia and/or bacteremia; mean ABSI 8.5) showed a consistent and characteristic increase in PSP levels (>350 ng/mL) over time, with elevations preceding the clinical diagnosis of infection (24-120 h). In contrast, patients without pneumonia or bacteremia (mean ABSI 6) exhibited low and stable PSP (<150 ng/mL) concentrations throughout the observation period, despite the presence of burn-related injury and the expected sterile inflammatory response. Conclusions: In this exploratory cohort study distinct PSP trajectory patterns, with persistently low levels in non-infected patients and rising levels preceding clinically diagnosed infection in several cases, were observed. These preliminary findings suggest that longitudinal PSP monitoring may provide potential utility for infection surveillance in burn ICU patients. However, due to the exploratory design and very limited sample size, the findings should be interpreted cautiously and require validation in larger prospective multicenter studies before conclusions regarding clinical decision-making or patient outcomes can be drawn.

This case report describes the clinical course of necrotising fasciitis as a serious complication following outpatient liposuction. The patient required extensive surgical procedures, including radical debridement, negative pressure wound therapy (NPWT) and multiple flaps to cover the extensive tissue defects, alongside prolonged intensive medical care. This case underscores the risks associated with aesthetic procedures and emphasises the importance of having such procedures performed exclusively by qualified and experienced specialists. This case also impressively demonstrates the importance of early diagnosis and interdisciplinary management.

Background and Objectives: Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are rare yet life-threatening dermatologic conditions characterized by severe skin and mucous membrane involvement. Accurate prognostic systems are crucial for clinical management to assess disease severity and predict outcomes. The primary objective of this study was to assess the epidemiological characteristics and clinical outcomes of patients with Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap over a 17-year period at a specialized burn center. The secondary objectives were to evaluate the performance of existing prognostic scoring systems (SCORTEN, Re-SCORTEN, and ABCD-10) in predicting mortality and to propose a novel classification tree model to improve mortality prediction. Materials and Methods: A 17-year retrospective study at a burn center included 68 patients with SJS, SJS/TEN overlap, or TEN. Demographic, clinical, laboratory data, and prognostic scores (SCORTEN, Re-SCORTEN, ABCD-10) were collected and analyzed for associations with mortality. A classification tree was created to detect unknown determinants of SJS/TEN mortality. Results: The drug most frequently associated with the occurrence of SJS/TEN was metamizole. The mortality rate was 51%. Affected body surface area, platelet count, and serum blood urea nitrogen differed significantly between survivors and non-survivors. Regarding the scoring systems, only the Re-SCORTEN showed reliable differentiation for these groups. A classification tree model achieved an accuracy of 89% in predicting the mortality risk. In the ROC curve analysis, the AUC values were 0.88 for the classification tree, 0.66 for Re-SCORTEN, 0.61 for SCORTEN, and 0.56 for ABCD-10. Conclusions: This study explores mortality predictors in SJS/TEN via a classification tree model, highlighting potential factors for further investigation. While cautioning against immediate clinical application due to data constraints, the findings underscore the need for larger studies to validate and refine prediction models in this context.

Background/Objectives: Enzymatic debridement with NexoBrid® is an effective alternative to surgical debridement in burn care, but its potential systemic effects remain unclear. In the context of personalized burn care, understanding individual patient responses to topical agents is essential to optimize outcomes and minimize risks. This study aimed to characterize laboratory and clinical parameter changes following NexoBrid® application in patients with small burn injuries (≤10% TBSA). Methods: We retrospectively analyzed 75 burn patients treated with NexoBrid® to evaluate changes in systemic inflammatory markers, coagulation parameters, and clinical parameters before and after enzymatic debridement. Results: Statistically significant increases in body temperature (p = 0.018), decreases in hemoglobin (p < 0.001), and increases in C-reactive protein (CRP) levels (p < 0.001) were observed, suggesting mild systemic inflammatory changes. However, leukocyte counts did not change significantly (p = 0.927), and body temperature remained within the normothermic range, indicating that these changes were not clinically significant. A significant decrease in the prothrombin time ratio (% of normal; p = 0.002) was also observed, suggesting potential impacts on coagulation. Importantly, while body temperature was slightly higher in patients with a higher degree of BSA exposure within the ≤10% TBSA cohort (p = 0.036), the extent of NexoBrid® application did not correlate with other inflammatory markers. Conclusions: These findings suggest that measurable systemic changes can occur following NexoBrid® application in small burns, particularly affecting inflammatory and coagulation parameters. These observations contribute to the understanding of treatment-related responses and may help inform clinical decision-making.

Große sowie voluminöse Weichteildefekte im glutealen, perinealen und sakralen Bereich sind eine rekonstruktive Herausforderung, insbesondere, wenn geeignete lokale Lappenplastiken nicht vorhanden sind. In solchen Fällen kann eine freie Lappenplastik erforderlich sein, deren Wahl von Defektgröße, -tiefe und den verfügbaren Empfängergefäßen abhängt. In dieser Arbeit werden verschiedene Optionen zur Defektdeckung in diesem Bereich analysiert und evaluiert. Besonderes Augenmerk liegt auf der Wahl des Empfängergefäßes, der Lappenplastik und der Operationsplanung. Freie Lappenplastiken sind eine effektive und sichere Methode zur Rekonstruktion großer Weichteildefekte im glutealen, perinealen und sakralen Bereich. Die A. glutea superior und inferior sind die bevorzugten Empfängergefäße, jedoch können arteriovenöse Loops als Alternativen dienen, wenn primäre Gefäße nicht verfügbar sind. Während die Latissimus-dorsi-Lappenplastik sich besonders für flächige Defekte eignet, bietet die Vastus-lateralis-Lappenplastik durch ihr Volumen Vorteile für tiefe bzw. voluminöse Defekte. Die mikrochirurgische Rekonstruktion dieser Defekte erfordert eine individuelle Planung, abhängig von Patientenfaktoren, Defektmorphologie, und vaskulären Gegebenheiten. Die Wahl der geeigneten Lappenplastik sowie eine sorgfältige Selektion des Empfängergefäßes sind entscheidend für den rekonstruktiven Erfolg dieser komplexen Prozedur.

Background/Objectives: Free gracilis (GM) and latissimus dorsi muscle (LDM) flaps are reliable options for complex defect coverage, but long-term sensory outcomes remain underexplored. Sensory impairment, especially the loss of protective cutaneous sensation, increases the risk of injury, thermal damage, and ulceration in reconstructed areas. This study aimed to systematically assess multidimensional sensory recovery after free muscle flap (FMF) reconstruction. Methods: In a prospective single-center study, 94 patients (49 GM, 45 LDM) underwent standardized sensory testing following FMF transfer. Five modalities were evaluated: pressure detection (Semmes-Weinstein monofilaments), vibration perception, two-point discrimination (2PD), sharp–dull differentiation, and temperature differentiation. Measurements were compared to contralateral healthy skin (CHS). Subgroup analyses were performed by anatomical region (head, trunk, extremities). Results: All sensory modalities were significantly impaired in FMF compared to CHS (p < 0.0001). Mean pressure thresholds were markedly higher in FMF (248.8 g) versus CHS (46.8 g). Vibration perception scores were reduced (FMF 3.97 vs. CHS 5.31), and 2PD was significantly poorer (11.6 cm vs. 4.7 cm). Sharp–dull and thermal discrimination were largely absent in FMF (positivity rates < 20%), with 58.5% of patients demonstrating only deep pressure sensation (≥300 g). No significant differences were found between GM and LDM in most modalities, except for worse 2PD in GM. Subgroup analyses confirmed uniform deficits across all anatomical regions. Conclusions: FMFs without neurotization result in profound, persistent sensory deficits, particularly the loss of protective sensation. Clinically, fascio-cutaneous flaps with nerve coaptation should be considered in functionally critical regions. Future strategies should focus on neurotization techniques to enhance sensory recovery.

PURPOSE:The management of soft tissue sarcoma (STS) at reference centers with specialized multidisciplinary tumor boards (MTB) improves patient survival. The German Cancer Society (DKG) certifies sarcoma centers in German-speaking countries, promoting high standards of care. This study investigated the variability in treatment recommendations for localized STS across different German-speaking tertiary sarcoma centers. METHODS:In this cross-sectional case-based survey study, 5 anonymized patient cases with imaging data of localized STS were presented to MTBs of 21 German-speaking tertiary referral hospitals. Centers provided recommendations on treatment sequence and modalities, along with the consensus level within their MTB. Agreement percentages were calculated, and consensus levels were rated on a scale of 1 to 10. RESULTS:Five patient cases were discussed resulting in 105 recommendations. Agreement percentages for case 1 to 5 were 14.3%, 61.9%, 33.3%, 52.4% and 9.3%, with a median agreement percentage of 33.3%. Grouping pre- and postoperative therapies as "perioperative" and including recommendations with and without regional hyperthermia raised the median agreement to 47.6%. The mean consensus level within each center across all 5 cases was 9.5. CONCLUSION:This first case-based analysis of inter-center agreement for STS management in German-speaking countries reveals low inter-center agreement but high intra-center consensus. Our study includes nearly all tertiary sarcoma centers in German-speaking countries, affirming its strong external validity. These findings suggest potential and clinically very relevant differences in treatment standards among sarcoma centers. Enhanced case-based exchanges and collaborative efforts are needed to reduce discrepancies and standardize the management of STS patients.

Dieser Fallbericht beschreibt den Verlauf einer nekrotisierenden Fasziitis als schwerwiegende Komplikation nach einer ambulanten Liposuktion. Die Patientin benötigte neben einer prolongierten intensivmedizinischen Behandlung umfangreiche chirurgische Eingriffe, einschließlich radikalen Debridements, Vakuum-Therapie (NPWT) und multipler Lappenplastiken, um die ausgedehnten Gewebedefekte zu decken. Der Fall hebt die Risiken hervor, die mit ästhetischen Eingriffen verbunden sind und unterstreicht die Bedeutung diese Eingriffe nur durch erfahrene, qualifizierte Fachärzte durchführen zu lassen. Zudem zeigt dieser Fall eindrucksvoll die Wichtigkeit einer frühzeitigen Diagnosestellung sowie eines interdisziplinären Managements.

Large and bulky soft tissue defects in the gluteal, perineal and sacral regions are a reconstructive challenge, especially if suitable local flaps are not available. In such cases, a free flap may be necessary, the choice of which depends on the size and depth of the defect and the available recipient vessels.In this study, different options for defect coverage in this area are analysed and evaluated. Particular attention is paid to the choice of recipient vessel, flap and surgical planning.Free flap is an effective and safe method for the reconstruction of large soft tissue defects in the gluteal, perineal and sacral regions. The superior and inferior gluteal arteries are the preferred recipient vessels, but arteriovenous (AV) loops can serve as alternatives when primary vessels are not available. While the latissimus dorsi flap is particularly suitable for flat defects, the vastus lateralis flap offers advantages for deep or voluminous defects, due to its volume.Microsurgical reconstruction of these defects requires individual planning, depending on patient factors, defect morphology and vascular conditions. The choice of the appropriate flap and careful selection of the recipient vessel are decisive for the reconstructive success of this complex procedure.

Introduction: The Abbreviated Burn Severity Index (ABSI) by Tobiasen, which is commonly used to estimate the mortality risk of severely burned patients, calculates an additional point for the existence of full-thickness (third-degree) burns. [1] However, the score does not consider the extent of the body surface affected by third-degree burns. To understand whether there is a way to improve ABSI prediction power, this study aims to determine the influence of full-thickness burns on survival rates and how it affects the predictive precision of the ABSI. Material and methods: In this study, the statistical evaluation of 2538 patients collected prospectively in the context of the German Burn Registry was carried out. A linear regression analysis was carried out to show the prognostic relevance of full-thickness burns. Age, sex, total body surface area burned (TBSA), and the presence of inhalation injury were also observed as further influencing factors. Results: Among the 2538 patients meeting our inclusion criteria, full-thickness burns were found in 1233 patients. In patients with a TBSA below 20 %, the extent of full-thickness burns is not relevant to the prognosis in terms of survival probability (p = 0.124). With more than 20 % TBSA, the extent of third-degree burns is of significant relevance (p = 0.000). In patients without full-thickness burns and calculated ABSI values >= 12 the survival rate of 46 % was noticeably better than the predicted survival rate of < 10 % according to the ABSI Score, whereas the predicted survival rate in patients with third-degree burns (< 10 %), closely matched the observed survival rate of 11 %. Conclusion: For patients with a TBSA < 20 %, the presence of full-thickness burns is not relevant for survival. In contrast to this observation, the percentage of full-thickness burns is of crucial prognostic importance for patients with a TBSA of > 20 %. By adjusting the ABSI and taking into account the exact percentage of third-degree burns, an improvement in the prognostic precision of the score could be achieved. (c) 2024 Elsevier Ltd and ISBI. All rights are reserved, including those for text and data

Background: Necrotizing fasciitis (NF) is a life-threatening and rare condition. However, we report and analyze a remarkably high number of NF cases during the coronavirus disease 2019 (COVID-19) pandemic and especially in the first months after the COVID-19 pandemic. Patients and Methods: We conducted a retrospective analysis of 17 cases of NF treated in our clinic between January and May 2023. Data were collected on demographics, comorbidities, risk factors, laboratory findings, and clinical outcomes. For each individual case two risk indicating scores, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF) were calculated. Results: In the pandemic years 2021 and 2022 there were 21 and 30 patients with NF, respectively, treated in our clinic. Of the 17 included NF cases in this study from January until May 2023, 16 cases required intensive care unit (ICU) admission, six cases required limb amputation, and four cases resulted in death. The microbiologic examination revealed seven cases of polymicrobial infections, eight cases of monomicrobial infections primarily caused by Streptococcus pyogenes, and two cases without microbial growth. The LRINEC score showed a sensitivity of 82%, whereas the LARINF score demonstrated a sensitivity of 100% for identifying cases of NF. Conclusions: This study highlights a notable increase in NF during and after the COVID-19 pandemic, predominantly associated with Streptococcus pyogenes-induced infections. These cases demonstrate a highly aggressive nature, leading to limb amputation or death in more than half of the cases.

Summary: This case report presents a rare complication after percutaneous needle fasciotomy for Dupuytren contracture: the development of epidermoid cysts. A 60-year-old man who had previously undergone a needle fasciotomy required a subsequent limited fasciectomy due to disease progression. Unexpectedly, epidermoid cysts were discovered during the procedure. The successful removal of the cysts, together with the removal of the contracture cord, resulted in a good functional outcome. The conducted literature review identified four case reports of epidermoid or dermoid cysts after treatment for Dupuytren contracture. The reported cases in the literature and our case emphasize the need for adaptability in the management of Dupuytren contracture and the potential for unexpected complications. Further investigation is essential to understand the relationship between Dupuytren disease and cyst formation.

Summary:. Necrotizing fasciitis is a rare yet severe complication after body contouring surgery. We present a case of a 54-year-old woman with a complex medical history who developed necrotizing fasciitis 9 days after panniculectomy and epigastric hernia repair. Microbiological examination revealed Finegoldia magna as the causative agent, a rare pathogen in necrotizing fasciitis. Patients undergoing body contouring may be at increased risk of developing necrotizing fasciitis; therefore, increased attention should be paid to this differential diagnosis in case of postoperative signs of infection. This case report highlights the pivotal importance of early recognition, prompt surgical intervention, and comprehensive medical treatment to improve patient outcomes in necrotizing fasciitis.

OBJECTIVE:To evaluate the clinical outcome of the Karydakis flap procedure performed by a single surgeon for the treatment of pilonidal sinus, focusing on postoperative complications, recurrence rate, wound healing time, and return to daily life. METHODS:Authors performed a retrospective data analysis of patients who underwent reconstruction of pilonidal sinus using the Karydakis technique at the Department of Plastic, Reconstructive and Hand Surgery, Center for Severe Burn Injuries of Paracelsus Medical University, Klinikum Nürnberg, Germany, between 2014 and 2021. All cases were performed by a single surgeon. Patients were requested to attend a follow-up appointment in person or, if this was not possible, by telephone. RESULTS:A total of 103 patients were enrolled in the study. The postoperative complication rate was 11.7%. Revision surgery was required in 4.9% of patients because of a complication. Wound healing time was on average 21.4 days postoperatively. A total of seven patients (6.8%) had a recurrence within 59 months postoperatively. CONCLUSIONS:The Karydakis flap is a robust reconstructive off-midline procedure for the treatment of pilonidal sinus. Relatively few postoperative complications and a low recurrence rate are advantages of the surgical procedure. Based on the results of quality-of-life factors, patients experience early functional return to daily life after the Karydakis flap procedure.

This report presents a case of necrotizing fasciitis following a seemingly minor injury sustained from handling a spiny plant. Despite initial primary care by a physician, the patient presented with severe septic shock and necrotizing fasciitis of the hand, necessitating emergency surgical intervention. The use of scoring systems aided in the prompt recognition of the condition. Subsequent surgery was required due to infection progression, leading to significant soft tissue defects and functional impairment. The patient underwent multiple reconstructive procedures, including placement of dermis-replacement material and, ultimately, free flap reconstruction, to restore the hand function. This case report highlights the importance of rapid identification of potential cases of necrotizing fasciitis in cases of hand infections, demonstrates that scoring systems can assist in smaller affected body sites such as the hand, and illustrates the difficulties of defect reconstruction following necrotizing fasciitis.

Introduction: Necrotizing fasciitis (NF) is a critical disease with high morbidity and mortality rates that poses significant challenges in diagnosis and treatment. Prognostic factors for the clinical course of NF remain unclear and are currently under research. This study aims to identify such factors in a large cohort of patients which represents a major comprehensive investigation of prognostic factors for NF. Methods: Retrospective analysis was conducted on necrotizing fasciitis cases from 2003 to 2023 at two German hospitals. Data included demographics, comorbidities, laboratory findings, infection site, causative microorganisms and outcomes. Statistical analysis involved t-tests, chi-square tests, and ROC analysis. Results: A total of 209 patients were included, with a mortality rate of 18%. Patients were categorized into survivors (n = 171) and non-survivors (n = 38). Non-survivors were significantly older (68.9 ± 13.9 years vs. 55.9 ± 14.3 years; p < 0.01) and exhibited a higher prevalence of peripheral vascular diseases, cancer, and heart, liver, or renal insufficiency. Laboratory findings and scoring results also varied significantly between the two groups. The ROC curve analysis identified age as a predictor of mortality, with an optimal cut-off value of 68.5 years (sensitivity: 60.5%, specificity: 81.9%). Higher age was associated with increased mortality risk. Conclusions: The patient’s age stands out as the primary predictive element for mortality in necrotizing fasciitis. Additionally, we advocate for employing the Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF—score), which holds substantial prognostic significance and is straightforward to calculate. Considering our findings, crafting a clinical algorithm or scoring mechanism to forecast mortality in NF would be a promising target for future research.

Background: For years, surgical debridement with autografting has been considered the standard of care in the treatment of severe burns of the hand. However, in recent years, enzymatic debridement has increasingly been reported as a good alternative, especially for burns of the hand, as it selectively preserves viable tissue. In this study, we aim to evaluate the long-term function of the hand after enzymatic debridement in deep dermal burns. Methods: A retrospective chart review was conducted as well as measurements of subjective and objective outcome measures through physical examination and Disabilities of the Arm, Shoulder, and Hand (DASH), Patient and Observer Scar Assessment Scale (POSAS), and Vancouver Scar Scale (VSS) scores. Results: A total of 32 enzymatically debrided hands of 24 patients were included with a mean age of 42.4 ± 16.8 years and a mean follow-up of 31 months. Postoperatively, 19 of these could be managed conservatively using skin substitutes such as “Suprathel”, 13 had to undergo subsequent autografting. The mean DASH score for the entire study population was eight with a mean value of four in the conservatively managed group and fourteen in the autografted group. The mean Patient, Observer POSAS, and VSS values were nineteen, thirteen, and two. A total of 30 cases showed an effortless complete fist closure, and, also in 30 cases, patients attested to be satisfied with the esthetic appearance of the hand on being asked. Conclusions: The descriptive analysis of these results in our study population suggests that the enzymatic debridement of deep burns of the hand, especially combined with subsequent conservative management with skin substitutes, was associated with low long-term hand disability scores at a follow-up of two years.