The treatment of thermally injured hands has changed in the last 20 years. An early necrectomy and grafting with split-skin grafts is recommended by most burn specialists. The outcome in regard to cosmetic and functional results could be improved by early grafting. Meanwhile unnecessary grafts in burns with indeterminate depth can be avoided by new skin replacements. The new epithelial substitute Suprathel is marked by a considerable reduction of pain if it is applied on second degree burns. Therefore the mobilisation of the burned patient can be accelerated. Many hand burns were treated by Suprathel in our burn centre without severe scarring and without loss of function. We treated 76 inpatients with thermally injured hands in our burn centre from January 2004 to July 2006. Only 28 (25.7 %) of all 109 afflicted hands required a primary skin grafting. Suprathel was applied primarily in 78 hands (71.6 %). 3 hands were treated otherwise. 8 of the hands which were primarily treated by Suprathel (10.3 %) required a well-aimed grafting after one or two weeks, 70 (89.7 %) had a complete epithelisation without grafting. Many skin grafts could be avoided. We modified our strategy for the treatment of burned hands by our excellent experiences with Suprathel.