Burn scar contracture is the tightening of the skin after a second or third degree

burn A burn is an injury to skin, or other tissues, caused by heat, electricity, chemicals, friction, or ionizing radiation (such as sunburn, caused by ultraviolet radiation). Most burns are due to heat from hot fluids (called scalding), soli ...

. 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 A scar (or scar tissue) is an area of fibrosis, fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other Organ (anatomy), organs, and biological tissue, t ...

can result in restriction of movement around the injured area. This is mediated by myofibroblasts.

Diagnosis

Treatment

The treatment of burn scar contracture and deformity begins upon hospitalization. Wound care and functional outcomes can be predicted from the initial assessment of wound depth and location. Epidermal and partial thickness wounds heal in 1 to 3 weeks through epithelial migration from the wound edges and epithelial budding from the appendages of the

sweat Perspiration, also known as sweat, is the fluid secreted by sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and Apocrine sweat gland, apocrine glands. The eccrine sweat glands are distribu ...

and hair glands. These wounds pose only a small risk of contracture and hypertrophic scarring. Full-thickness (FT) injuries cause dermal wound healing, which is characterized by maturation (contraction and increased tensile strength), proliferation (

collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...

synthesis leading to wound closure), and

inflammation Inflammation (from ) is part of the biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants. The five cardinal signs are heat, pain, redness, swelling, and loss of function (Latin ''calor'', '' ...

(

edema Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...

). FT wounds heal by excision and grafting, contracture, or epithelial ingrowths from the margins. Because of insufficient tissue length and extensibility, severe damage to the integument system may result in significant impairment and

disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be Cognitive disability, cognitive, Developmental disability, d ...

. By using stress-strain curves, where stress is equal to force and strain is equal to tissue elongation, mechanical engineering principles can be used to assess the biomechanics of skin and scars. Stretching an adult burn scar is similar to stretching a

tendon A tendon or sinew is a tough band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tensi ...

in terms of elasticity. On the other hand, persistent force applied to tissue will cause it to elongate, which will lead to a plastic change in length and an increase in range of motion. Fast and forceful stress is much less effective than a gentle, prolonged stretch that the patient can tolerate. By applying a mild, prolonged stress to the healing tissue at its longest length for at least 6 to 8 hours per day during the healing process, burn rehabilitation aims to prevent and treat scar contracture and deformity. Tolerable pain threshold and scar blanching are used to gauge the extent of treatment. The position of comfort becoming the position of contracture is one of the main treatment tenets, with an emphasis on range of motion first and strength training second. It is possible to protect healing wounds while preserving tissue length by using a variety of positioning and splinting techniques. Hypertrophic scarring is a common development in wounds that take longer than two or three weeks to heal. This frequently happens weeks after the wound was closed. If compression is applied as soon as the wound heals and is kept at a pressure of about 24 mm Hg, raised scarring can be avoided. A scar is deemed mature when it is avascular, flat, pliable, and soft, and immature if it is red, raised, and/or stiff. It can take six months to five years for scars to fully mature. The hands and face should receive particular attention in order to reduce the likelihood of long-term impairment and disability, as they are the body parts most frequently burned and have the highest rate of burn scar contracture.

References

External links

{{Cutaneous keratosis, ulcer, atrophy, and necrobiosis, state=collapsed Scarring Burns

Diagnosis

Treatment

See also

References

Further reading

External links