What are Burn Scars / Deformities / Contractures?

Burns heal by growing and replacing the damaged layer of skin. The tissues in the wound start to dehydrate and contract forming Contractures. A contracture may cause limitation of movement if present on a joint or it may lead to unsightly appearance of the affected part due to pull on the surrounding healthy tissues.The burnt tissue usually undergoes a period of maturation for the next 12 to 24 months. Burns may result in the following deformities:
Keloid Scars - Keloids are thick, itchy, unsightly clusters of scar tissue that grow beyond the borders of actual burn wound. Keloids are formed due to excessive production of collagen by the body after the scar has healed. These scars sometimes appear red compared to the surrounding skin. Keloids are more common in dark skinned people and are more likely to develop in the earlobe, along the border of the jaw, the shoulder and the skin over the breast bone.

Hypertrophic Scars - Hypertrophic scars look like keloid scars except the fact that they tend to remain within the boundaries of the burn wound.

Burn Deformities / Contractures - Contractures occur when a Burn Scar pulls on the edges of the skin making a tight area. These Contractures can produce functional limitation and can affect the muscles, joints, and tendons. Contractures are usually common after Burns and are commonly referred to as Burn Deformity. When a large area of skin is lost due to a Burn, the surrounding intact skin pulls together to make up for the lost area of skin, thus forming a deformity that can limit your movement or function of that part of the body.

Depending on the type of scar, different surgical procedures are employed for Burn Scars / Deformities / Contractures. These surgical procedures are called Scar Revision and is usually performed under local or general anesthesia. Some of the Scar Revision procedures that are used popularly include:

•  Surgical removal of Keloid tissue - Surgery directly removes the keloid tissue and a skin graft may be used to cover the area. Skin Grafting is performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the surgery area.

•  Laser Surgery - Different lasers are used to smooth, flatten or remove abnormal discoloration of the overlying skin of the scar.

•  Skin Grafting - The procedure of skin grafting involves replacing the damaged area of the skin by healthy area taken from other part of the body.

•  Skin Flap Surgery - Flap surgery is a procedure in which skin, along with the underlying fat, blood vessels, and sometimes the muscle, is moved from a healthy part of the body to the injured site.

•  Z - Plasty - This is a Scar Revision procedure in which a Z-shaped incision is used. Z - Plasty is used to decrease the skin 'pull' in case of a contracture. This technique can also be used to try and blend the Scar in the natural creases and folds of the surrounding skin.

•  Tissue Expansion - The technique of tissue expansion is used in conjunction with skin flap surgery. In this technique the amount of existing tissue is increased for re-constructive purposes.

•  Dermabrasion - This procedure is used to smooth Scar tissue by shaving or scraping off the superficial skin layers of the skin. The goal of this procedure is to improve the appearance of the Scars over time.

Physical and Occupational Therapy is a very important part of rehabilitation for people suffering from Burn Scars / Deformities / Contractures as it may limit your activities to a great deal. Rehabilitation process following Burn injury is a very long one and the goal of this process is to maintain the best possible range of motion. Some of the methods of Physical and Occupational Therapy include:

•  Massage Therapy - Repeated massages over areas of healing burn tissue may help preserve softer, more flexible tissue, avoid scar contractures and reduce itching and pain. Combining heat application while massaging the area can increase tissue flexibility.

•  Pressure Garments - Elastic garments, elastic bandage wraps, sock-type pressure bandages are specifically designed pressure garments to apply consistent pressure over areas with healing burns. Inserts can be worn under the pressure garments to ensure more uniform pressure

•  Physical Therapy (Active and Passive Exercise Therapy) - Exercise is a very important component of post-burn rehabilitation. Your Physical and Occupational Therapist will teach you 'range of motion exercises' to help keep you muscles and joints flexible. Following an exercise regimen regularly increases motion and mobility and maintains body strength and a positive attitude. The best exercise is walking which not only increases your flexibility, it also decreases the likelihood of having blood clots.

Treatment of Burn Scars / Deformities / Contractures is performed not only for esthetic reasons, it is also performed for reconstructive and functional reasons. Keloids and Contractures are not just unattractive and ugly to look at, they can be extremely limiting if they are are on your hand, around your mouth or on a joint surface. Treatment of Burn Scars / Deformities / Contractures by Scar Revision does not just make them less obvious, it can also improve the function of the affected part.

•  Bleeding
•  Infection
•  Allergic reaction to anesthesia
•  Numbness
•  Recurrence of Scar

It is your personal preference as to how much your Scars bother you and what you want to do about it. Depending on the depth and size of the wound and severity of scarring, it is worth while considering the different treatment techniques that are available and widely used by plastic surgeons around the globe.