Steroid injections. Steroids are injected directly into scar tissue to reduce the itching, redness, and burning that these scars can create. Sometimes injections help reduce the size of the scar and soften the scar tissue. Atrophy and discoloration of the skin are the main side effects. After the complete release of a post-burn contracture, the restored defect should be covered with skin grafts or a flap of skin. Most often, the raw areas that occur after the release of contractures after the burn are covered with skin grafts. Flap lids are used in special situations. Z plastics, multiple Z plastics, and local flap reconstruction are often required to adequately release scar contracture.6 The medial canthus strap, mouth commissure, and neck are particularly well suited for reconstructing one or more Z-plastics. It is important to use pressure and ROM exercises to prevent the development of contractures after revision. By definition, scar contracture is the result of a contractile healing process that occurs in a scar that has already been reepithelialized and sufficiently healed (Fig. 2C).6 Scar contractures usually appear as a firm, rigid scar that contributes to both aesthetic and functional problems.
It is imperative that the reconstructive surgeon distinguishes between these three forms, as they require different treatment modalities. Donor sites: Split skin grafts are usually harvested from the thighs. However, in a severely burned patient with extensive scars, grafts may need to be removed from the legs, upper limbs and abdomen, scalp or back. During a neck contracture after the burn, scars can extend from the chin, neck to chest and even on the abdomen. Here, only the scars of the neck are cut. The use of a CO2 laser versus cold steel for keloid excision has not been shown to reduce the rate of recurrence when used as a single treatment method.49s0 Leaving a tissue edge after excision has been shown to result in decreased recurrence and may offer some benefits. Engraving et al. reported improved outcomes in intramarginal excision compared to extramarginal excision.51 As mentioned earlier, surgical excision alone is likely to cause recurrence, which is why intralesional corticosteroids are recommended after excision. These injections are continued every 4 to 6 weeks for 6 months. Patients are followed every 3 months for at least 2 years.
Cryosurgery. Cryosurgery can help reduce the size of scars by freezing the upper layers of the skin. Freezing causes blisters to form on the skin. Radiation. This can be used for scars that do not respond to other treatments. Mortality and morbidity from burns have declined dramatically over the past six to seven decades. However, these do not really reflect whether the victim could return to society as a useful person and live a normal life, because after burns, scars, contractures and other deformities that together have aesthetic and functional considerations are inevitable . . .