Burn scar contracture

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Burn scar contracture
Synonyms	Scar contracture
Pronounce	N/A
Specialty	N/A
Symptoms	Tightness of skin, restricted movement, pain
Complications	Functional impairment, cosmetic issues
Onset	After burn injury
Duration	Chronic
Types	N/A
Causes	Burns, trauma
Risks	Infection, poor wound healing
Diagnosis	Physical examination, medical history
Differential diagnosis	Hypertrophic scar, keloid
Prevention	Proper wound care, physical therapy
Treatment	Surgery, physical therapy, compression garments
Medication	N/A
Prognosis	Varies, can improve with treatment
Frequency	Common in severe burn cases
Deaths	N/A

Burn scar contracture is the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area. This is mediated by myofibroblasts.

Treatment

Burn scar contractures do not go away on their own, although may improve with the passage of time, with occupational therapy and physiotherapy, and with splinting. If persistent the person may need the contracture to be surgically released. Techniques may include local skin flaps (z-plasty) or skin grafting (full thickness or split thickness). There are also pharmacy and drug-store treatments that can be used to help scar maturation, especially silicone gel treatments. Prevention of contracture formation is key. For instance, in the case of a burned hand one would splint the hand and wrap each finger individually. In the instance of burns on the neck, hyperextension of the neck (i.e. no use of pillows) should be maintained during the healing process. Carbon dioxide laser therapy is now also used to aid in the loosening of surrounding skin, although is yet to form as part of an official global rehabilitation program.

References

<ref>Hariharan N C, Sridhar R, Sankari B, Valarmathy VS, Asirvatham E, Geetha K. "Reconstruction of postburn crippled hands: A study of functional outcome" Indian J Burns 2018;26:9-14.</ref>