Preventive measures for scar development, especially after skin grafting, include the use of splints, generally on your neck, arms and hands. Keeping the scarred area immobilized helps the healing process. Extreme immobilization, as in burns of the neck, leads to diminished contracture.
In burns, contracture usually appears when the scar line is vertical to the natural 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 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 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 produces a restriction of the full range of motion, skin grafting or the use of a flap is indicated to hide the tissue defect.
Tissue expanders can be used today in several shapes and volumes as a auxiliary 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 choose which procedure to use.
Hypertrophic scars are more commonly seen in burn injuries. It is medically very difficult to differentiate them from keloids arising from burn injuries, although they are different pathological entities.
Hypertrophic scars always develop when the main excision is delayed more than 10 days post-burn. Due to aseptic inflammation, it is not recommendable to operate before the first eight months, unless the scar causes functional disorders. Meanwhile, various conservative measures can be used, depending on the scar extent.
Localized scars of small extent are usually treated with hormonal 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 apply the medication intralesionally, because of the fibers density. The jet-machine has the property of having the right pressure, and the moment of "firing", to apply the medicine 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 needed, although it causes a destruction of the fibers. The reaction to the treatment must be controlled 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 change is the last of the symptoms to be recovered and is observed some months after the treatment is done.