Preventive measures for scar development, in particular after skin grafting, include the use of splints, particularly on your neck, upper extremities 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 natural tension lines, as in scars crossing a joint. It should be emphasized that the primary treatment of the burn injury should actually intend 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 cover the defect and avoid 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 redirect the scar and minimize skin tension. If on the other hand the scar contracture leads to a diminishment of the full range of motion, skin grafting or the use of a flap is recommended to cover the tissue defect.

Tissue expanders can be applied today in several shapes and volumes as a auxiliary procedure to reconstruct lesions. Tissue expansion is not recommended 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 surgeon to choose which procedure to use.

Hypertrophic scars

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

Hypertrophic scars always appear when the main excision is delayed more than 10 days post-burn. Due to natural inflammation, it is not advisable to operate before the first eight months, unless the scar causes functional disorders. Meanwhile, several conservative measures can be used, 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 a simple 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 medicine intralesionally. It appears that the greatest advantage of the dermo-jet lies in the pressure, which causes a destruction of the irregularly woven fibers. It appears that steroids are also needed, although it causes 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 recovered and is observed some months after the treatment is finished.