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Preventive measures for scar development, in particular after skin grafting, include the application of splints, generally on your neck, upper extremities and hands. Keeping the scarred area immobilized helps the healing process. Extreme immobilization, as in burns of the neck, leads to minimized contracture.

Scar contractures

In burns, contracture commonly appears when the scar line is vertical to the skin tension lines, as in scars over a joint. It should be mentioned that the primary treatment of the burn wound should actually intend 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 scar contracture is scar revision, along with another surgical procedure, according to the place, extent and form 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 recommended to hide the tissue defect.

Tissue expanders can be applied today in different shapes and volumes as a secondary procedure to reconstruct defects. Tissue expansion is not optimal for a primary closure of an open wound. 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 procedure to use.

Hypertrophic scars

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

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

Localized scars of small extent are commonly 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 tissues density. The jet-machine has the ability of having the right pressure, and the moment of "firing", to insert the medication intralesionally. It seems that the greatest advantage of the dermo-jet lies in the pressure, which causes a destruction of the irregularly woven fibers. It seems that steroids are also needed, although it causes a destruction of the fibers. The reaction to the treatment should 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 recovered and is observed some months after the treatment is finished.