Preventive measures for scar development, especially after skin grafting, include the use of splints, particularly on your neck, arms and hands. Immobilizing the scarred area helps soften scars. 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 wound should actually aim to diminish scar contracture by grafting the patients as soon as possible. In some lesions 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, along with another surgical procedure, according to the place, extent and shape of the scar. For example, Z-plasty can reorient the scar and reduce skin tension. If on the other hand the scar contracture leads to 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 different shapes and volumes as a auxiliary procedure to reconstruct defects. Tissue expansion is not recommended for a primary closure of an open wound. In severe contractions skin grafts still produce as good results as the myocutancous or fasciocutaneous axial flaps. It is up to the doctor to decide which procedure to use.

Hypertrophic scars

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

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

Localized scars of small extent are usually treated with hormonal injections. The use of an air-jet apparatus ("dermo-iet") is more efficient than the injection with an ordinary needle. With such a needle it is more or less unlikely to apply the medication intralesionally, because of the fibers density. The jet-machine has the ability of having the right pressure, and the moment of "firing", to insert the medicine intralesionally. It seems that the greatest advantage of the dermo-jet lies in the pressure, which inflicts a destruction of the irregularly woven fibers. It seems that steroids are also needed, although it causes a destruction of the fibers. The response to the treatment should be evaluated after the second session, when the hyperti-lophic scar becomes softer and itching disappears. The treatment continues in sessions till the scar becomes lighter and softer. The color change is the last of the symptoms to be recovered and is observed some months after the treatment is done.