Fifty patients, with 71 hands affected by deep dermal burns, underwent tangential excision and immediate autografting at a mean of the fifth postburn day. Assessment of the group at 6 weeks showed an 8% mortality, good hand function in 50%, fair function in 18%, and poor function in 24%. The total group was partitioned into patients with burns of 40% or less and those with burns of greater than 40% of body surface. The former group had significantly better hand function than the latter. Early tangential excision with immediate autografting of deep dermal hand bums is recommended for almost all patients with small to moderate thermal cutaneous injury. However, only after careful evaluation should patients with large, life-threatening thermal injuries be selected for this procedure.