Preventive measures for scar development, especially after skin grafting, include the application 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 minimized contracture.

Scar contractures

In burns, contracture commonly shows 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 minimize 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 avoid contracture.

The treatment of choice for scarring contracture is scar revision, along with another surgical intervention, according to the place, 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 leads to a diminishment of the full range of movement, skin grafting or the use of a flap is recommended to hide the tissue defect.

Tissue expanders can be used today in different shapes and volumes as a secondary procedure to reconstruct lesions. Tissue expansion is not optimal for a primary closure of an open wound. In severe contractions skin grafts still give as good effects 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 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 main 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 steroid injections. The use of an air-jet apparatus ("dermo-iet") is more effective than the injection with a simple needle. With such a needle it is more or less impossible to inject the medication intralesionally, because of the tissues density. The jet-apparatus has the ability of having the appropriate pressure, and the moment of "firing", to insert the medication intralesionally. It appears that the greatest advantage of the dermo-jet lies in the pressure, which inflicts a destruction of the irregularly woven fibers. It appears that steroids are also necessary, although it causes a destruction of the fibers. The response to the treatment must be evaluated after the second session, when the hyperti-lophic scar appears softer and itching recedes. The treatment continues in sessions till the scar appears thinner and softer. The color variation is the last of the symptoms to be recovered and is observed some months after the treatment is done.