What are burn scar contractures?

Skin burn is the dying, peeling, or charring of a skin surface which comes in contact with dry or wet hot materials. Several types of skin burns are broadly classified into three categories:

First Degree Burns: when the burn injury causes a mild epidermal scar i.e., a scar over the outermost layer of the skin known as the epidermis.

Second Degree Burns: when the burn injury causes a mild to severe scar affecting the epidermis and the dermis which is the layer below it. Also known as a Split Thickness (ST) Burn’.

Third Degree Burns: when the burn injury causes a severe scar on all layers of the skin. Also known as a ‘Full Thickness (FT) Burn’.

A scar contracture is caused by a Second or Third-degree burn injury where the affected skin dries, tightens and contracts closer. 

Such degrees of scars are usually caused due to exposure of skin to fire, heated solids, heated liquids, or steam making the skin dry, numb, and charred. Such contraction of skin leads to a significantly limited range of motion, inflammation and even pain in some cases. These scars can also affect the deeper nerves, muscles and tissues under the skin whose treatment would require prompt surgical intervention.

How are burn scar contractures Treated?

Previously, such burn scar contractures were treated only after the scar has completely matured to avoid any additional infections or damage caused by treating an unhealed scar. The focus was primarily to keep the affected region alive without giving priority to restoring mobility and cosmesis. However, with several advancements in dermatology, the dermatologists today can treat a burn scar promptly before it matures and restores its functionality, mobility, and cosmetic appearance all through reconstructive surgery.

First degree burns can be easily treated with topical ointments like aloe vera cream, antibiotic ointment, and pain medications. However, second and third-degree burns where the skin lines have become disoriented, a reconstructive surgery technique can help in restoring its structure and aesthetics better than any non-surgical treatment. Post-burn skin reconstructive surgeries are mainly of two types:

Z-Plasty Surgery:

In case of moderate second-degree burns that are more linear and thin, and where at least 50% or more mobility or flexibility of the skin is retained, a Z-plasty or its variation technique can be used.

  • In a typical Z-plasty, the scar is at 90 degrees to the lines of skin tension. 
  • First, a single linear incision is made over the scar. Then, two incisions at an angle of 60 degrees are made at each end of this incision but in opposite directions, forming two triangular skin flaps.
  • Now, these two triangular skin flaps are transposed over each other such that the wound lengthens by 50% and the scar becomes parallel to the lines of skin tension by turning 90 degrees. 
  • These skin flaps are sutured in this transposed position where the scar hides within the borders of transposition making it less obvious.

ST and FT skin Grafting:

In case of severe third-degree burns where the mobility is less than 50% and no flexible skin to move, a skin graft from a healthy donor site can be used to replace the burned skin.

Depending on the extent of the scar, one of the two types of skin grafts may be required:

Split Thickness Skin Graft (STSG): Here, a specific size of epidermis and dermis layer is incised from the donor skin site.

Full Thickness Skin Graft (FTSG): Here, the entire thickness of donor skin is removed in perfect size and shape.

A skin graft is used to reconstruct the affected skin region such that there are no more contractures and the colour of skin looks similar throughout. 

There are many other ways to deal with skin burns and the contractures caused. If you’ve recently suffered from a burn and want to prevent skin contracture scars, promptly visit the Deccan Clinic in Pune and consult their dermatologist and reconstructive plastic surgeon for better results. You can visit the Deccan Clinic website to book your appointment immediately.

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