Scars / Deformities / Contractures:
is an injury
that is caused
by heat and
it results in
death of a tissue.
The nerve endings
may be damaged
due to Burns,
which may result
in immense pain
Causes of Burns can be:
- e.g. flame, hot liquids, steam, hot
Chemical - e.g. strong acids, strong
Electrical - e.g. lightening, high voltage
Radiation - e.g. ultraviolet light
Light - e.g. intense light
What are the
types of Burns?
Burns can be:
Degree Burns or Superficial Thickness
Burns - e.g. sunburn. This kind of Burn
is usually not serious as only the superficial
layer of skin is damaged. First Degree
Burns heal completely in 3 - 5 days.
There is no blistering and minimal scarring.
Second Degree Burns or Partial Thickness
Burns - Partial Thickness Burns cause
blistering and are very painful. In
this kind of Burn, superficial layer
of the skin is completely damaged however;
the deeper layer of skin is still intact.
There are 2 kinds of Partial Thickness
Superficial Partial Thickness Burns
- these kinds of Burns cause blisters
and can be quite painful. It takes
about 2 - 3 weeks to heal completely
and there is no scarring.
Deep Partial Thickness Burns - This
kind of Burn involves damage to
the deeper layers of the skin and
takes longer to heal. Deep Partial
Thickness Burns can result in numbness
of the affected area.
Third Degree Burns or Full Thickness
Burns - Full Thickness Burns involve
the entire thickness of the skin, there
is very little or no pain at the affected
Fourth Degree Burns - This kind of Burn
involves the deeper tissues like muscle,
tendons and bones.
Major Burns - All the Third Degree,
Fourth Degree and Second Degree Burns
that involve more than 15 percent of
the body surface in adults and more
than 10 percent in children are Major
Minor Burns - All First Degree Burns
are Minor Burns. Second Degree Burns
that involve less than 15 percent of
the body surface in adults and less
than 10 percent in children can also
be categorized as Minor Burns.
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:
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
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.
What are the
common sites for Burn Scars / Deformities
The most common sites for Burns to occur
are face, hands, head, neck, chest, ears,
perineum and feet require prompt attention.
are Burn Scars / Deformities / Contractures
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:
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
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.
How can you
prevent Burn Scars / Deformities / Contractures?
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 - 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
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.
Benefits of Treatment for Burn Scars
/ Deformities / Contractures
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
of Treatment for Burn Scars / Deformities
Allergic reaction to anesthesia
Recurrence of Scar
Alternatives to Treatment for Burn
Scars / Deformities / Contractures
Injections - Steroid injections can
reduce itching, redness and burning
sensation in the scar tissue and may
even reduce the size of the Burn Scar.
Cryotherapy - The scar tissue is frozen
off by medications
Localized pressure - Pressure is applied
to the Burn Scar with a pressure bandage
to reduce the size of the Scar. This
method is not too effective.
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