Preventive measures for scar formation, especially after skin grafting, include the application of splints, generally on your neck, arms and hands. Keeping the scarred area immobilized helps the healing process. Extreme immobilization, as in burns of the neck, leads to diminished contracture.

Scar contractures

In burns, contracture usually appears when the scar line is vertical to the natural tension lines, as in scars over a joint. It should be mentioned that the primary treatment of the burn injury should actually aim to diminish scar contracture by grafting the patients as soon as possible. In some cases pediele flaps or even free flaps can be used primarily to hide the defect and prevent contracture.

The treatment of choice for scarring contracture is scar revision, combined with another surgical intervention, according to the localization, extent and shape of the scar. For example, Z-plasty can reorient the scar and minimize skin tension. If on the other hand the scar contracture produces a restriction of the full range of motion, skin grafting or the use of a flap is indicated to hide the tissue defect.

Tissue expanders can be applied today in several shapes and volumes as a secondary procedure to reconstruct defects. Tissue expansion is not optimal for a primary closure of an open injury. In severe contractions skin grafts still produce as good effects as the myocutancous or fasciocutaneous axial flaps. It is up to the doctor to choose which method to use.

Hypertrophic scars

Hypertrophic scars are more commonly seen in burn injuries. It is clinically very hard to differentiate them from keloids arising from burn injuries, although they are different pathological entities.

Hypertrophic scars always develop when the primary excision is delayed more than 10 days post-burn. Due to natural inflammation, it is not recommendable to operate before the first 8 months, unless the scar causes functional disorders. Meanwhile, several conservative measures can be applied, depending on the scar extent.

Localized scars of small extent are usually minimized with hormonal injections. The use of an air-jet apparatus ("dermo-iet") is more effective than the injection with an ordinary needle. With such a needle it is more or less impossible to inject the medication intralesionally, because of the fibers density. The jet-apparatus has the property of having the appropriate pressure, and the moment of "firing", to insert the medication intralesionally. It seems that the main advantage of the dermo-jet lies in the pressure, which inflicts a rupture of the irregularly woven fibers. It seems that steroids are also necessary, although it promotes a destruction of the fibers. The response to the treatment must be controlled after the second session, when the hyperti-lophic scar becomes softer and itching recedes. The treatment continues in sessions till the scar becomes lighter and softer. The color variation is the last of the symptoms to be restored and is observed some months after the treatment is finished.