Burn Scars / Deformities / Contractures:

Burn 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 and discomfort.

What causes Burns?

Causes of Burns can be:

• Thermal - e.g. flame, hot liquids, steam, hot objects
• Chemical - e.g. strong acids, strong alkalis
• Electrical - e.g. lightening, high voltage electric current
• Radiation - e.g. ultraviolet light
• Light - e.g. intense light

What are the types of Burns?

Burns can be:

• First 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 Burns:

  • 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 site.
• 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 Burns.
• 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:

• 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 breastbone.
• 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 / Contractures?

The most common sites for Burns to occur are face, hands, head, neck, chest, ears, perineum and feet require prompt attention.

How are Burn Scars / Deformities / Contractures treated?

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.

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 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.

Benefits of Treatment for Burn Scars / Deformities / Contractures

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.

Risks of Treatment for Burn Scars / Deformities / Contractures

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

Alternatives to Treatment for Burn Scars / Deformities / Contractures

• Steroid 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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