An OTR® is performing an initial evaluation of a client with an acute full-thickness burn to the dorsum of the hand involving all digits. The OTR® is applying Boutonniére precaution and avoiding having the patient perform active or passive composite flexion of the fingers. What is the MOST APPROPRIATE clinical reasoning for this approach?

A. The tensile strength of the burned skin will not allow for composite flexion of the fingers.

B. A bulky dressing on the hand will limit the ability to form composite flexion of the fingers.

C. Immobilization is critical for the initial wound healing to avoid wound widening from movement.

D. Composite flexion of the fingers increases the risk of extensor dorsal hood disruption.

The clinical reasoning for applying Boutonniére precaution and avoiding having the patient form active or passive composite flexion of the fingers in the initial evaluation of a client with an acute full-thickness burn to the dorsum hand involving all digits is D. Composite flexion of the fingers increases the risk of extensor dorsal hood disruption.

This precaution is taken to prevent further damage to the extensor tendons and structures in the hand. It is important to immobilize the hand during the initial healing phase to allow for proper wound healing without the risk of additional injury.

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