Scars After Burns - Burn Scar Treatment

Scars After Skin Burning, Burn Scar Treatment, Burns Scars

People who experience skin burning and their loved ones face many challenges on the road to recovery, not the least of which are understanding the recovery process and finding helpful resources. The treatment of burn patients is a highly specialized field of medicine that can be difficult to comprehend for people trying to cope with the trauma of a serious burn injury.

The severity of a burn depends on how hot the skin gets and how long the burn lasts. The location is also important, because skin varies in thickness, water and oil content, the amount of subcutaneous fat, and the number of blood vessels from one location in the body to another. The diagnosis of a burn injury is based on how deep the injury is.

Short-term treatment of burns can include antibiotics, bandages, escharectomies, and pressure garments. Click here to learn more about short-term treatment methods. Skin grafts involve transplantation of skin from one area of the body to another. Some burns can be treated on an outpatient basis, while others require hospitalization.

Choices about long term burn care depend on the severity of the burn injury as well as whether the patient suffered lung injury from inhaling smoke or chemicals and whether there were pre-existing medical problems.


Scar evolution leads to three possible abnormalities: scar contractures, hypertrophic scars and keloids. As the quality of a scar is however unpredictable, preventive measures, including the use of fatty ointments and continuous pressure, should always be taken. Splints are also useful. The treatment of the three main abnormalities is described. No method is perfect and the aim in the treatment of burn scars must therefore be the prevention of abnormalities by early excision of the primary bum wound.

The scar is the end result of wound healing in the deep partial thickness and full thickness burns. According to its pathology, scar evolution leads to the formation of three different types of abnormality:

  • scar contractures
  • hypertrophic scars
  • keloids

  • The evolution of the scar depends on various factors, of which some can be altered by therapeutic measures. Others can influence the quality of the scar in a negative way, such as the site of the scar, its healing process, the age, sex and race of the patient, etc.

    Nevertheless, the quality of a scar is unpredictable, especially for the first 10-15 days after its appearance. For this reason preventive measures should be undertaken in time to avoid the manifestation of an abnormal scar.

    It has been demonstrated that fatty ointments penetrate easily into the scars and the surrounding normal skin. It seems that the maintenance of a fatty milieu around the scar diminishes the period of aseptic inflammation and excludes irritation by the exfoliation of the new scar.

    Many observations reveal that from the preventive point of view the combination of this treatment with continuous pressure has encouraging results, especially in extended burn scars.

    Pressure does not allow the formation of interstitial oedema and restricts the development of new capillaries, when applied in a range of 15-40 min Hg

    For this purpose silicone sheet garments have been invented. They should be applied two weeks after grafting or when spontaneous healing has occurred. Doctors recommend their use for 9-12 months, all day long, until the scars become soft, flat and pale in colour. But patients do not comply. An excellent alternative is the application of our BIOSKINCARE cream or ROSE HIP OIL or BIOBALM (the latter is made by combining both products).


    Application of fatty and/or cortisone containing ointment and creams
    Reduction of skin tension
    Application of continuous compression

    Preventive measures for scar formation, especially after skin grafting, include the use of splints, particularly in the neck, the upper extremities and hands. They lead, through immobilization, to a softening of the scar. Immobilization in an extreme extension position, 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 skin tension lines, as in scars over a joint. It should be emphasized 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 cases pediele flaps or even free flaps can be used primarily to cover the defect and prevent contracture.

    The treatment of choice for scar contracture is scar revision, combined with another surgical procedure, according to the localization, extent and shape of the scar. For example, Z-plasty can redirect 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 cover the tissue defect.

    Tissue expanders can be used today in different shapes and volumes as a secondary procedure to reconstruct defects. Tissue expansion is not recommended for a primary closure of an open wound. In severe contractions skin grafts still give as good results as the myocutancous or fasciocutaneous axial flaps. It is up to the surgeon to decide which method to use.

    Hypertrophic scars

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

    Hypertrophic scars always develop when the primary excision is delayed more than 10 days post-bum. Due to aseptic inflammation, it is not advisable 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 usually treated with steroid 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 impossible to inject the medicine 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 causes a destruction of the irregularly woven fibers. It seems that steroids are also necessary, 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 thinner and softer. The color change is the last of the symptoms to be restored and is observed some months after the treatment is finished.

    The surgical treatment varies depending on the extent and the site of the hypertrophic scar. Small scars can be revised and removed, the defect being covered by local or distant flaps. In extensive scars tension should be released primarily, because the scar will not soften and more importantly constant irritation may lead to the formation of precancerous lesions. The defects resulting from the relief of tension are covered by split thickness skin grafts, which in some cases are meshed.

    Small and multiple hypertrophic scars should be treated by dermabrasion. Avoid applying this method during the late spring and summer time with people of dark colored skin, since sun irradiation can result in deeper coloured areas of the skin. In our experience the results are not very satisfactory when dermabrasion is applied to people of darker skin, since it results in a whitish skin area.

    Irradiation should not be considered the therapy of choice in benign lesions and in particular in keloids, because of its serious side effects. The combination of excision and post-operative irradiation seems to have good aesthetic results without being of any harm to the patient.

    The application of continuous compression as well as of steroids is unfortunatelly not efficient for the treatment of keloids.

    The use of the C02-laser to excise the keloid combined with local compression has been recently applied but the results are not encouraging.

    The removal of the keloid and coverage of the defect with skin grafts or flaps, combined with continuous compression, seem to be the method which brings the most satisfactory results, and the fewest recurrences.

    In conclusion, the treatment of scars cannot be generalized and should always be individualized for each person. It should be stressed that efforts to treat bums must always include the consideration of facing a future disfiguring or disabling scar.

    It is evident that none of the above methods gives perfect results. For this reason the main aim in the treatment of burn scars is to limit their development by performing an early excision of the primary bum wound.

    Last modified: December 06, 2007

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