Scars and contractures All deep partial thickness burns result in scarring and in full thickness burns scars form at the margins of the graft and in the area which have healed by secondary epithelialisation. Burn scars, like all other scars, go through a series of phases, being initially flat and fairly inconspicuous, then red, thick and hard (hypertrophic scar), and finally flat, pale and soft. The pressure garment, local mild steroid application, systemic antihistaminic or silicone gel sheet cover can minimise the degree of hypertrophy and speed resolution. The secondary surgery, unless for urgent reason, should be delayed until the stage of hypertrophy has passed.
All scars and free grafts tend to shrink; thin grafts shrink more than thick ones. Contractures are, therefore, common sequelae to severe burns and late reconstructive procedures are often necessary. The shrinkage is maximum at three months and some relaxation of scar may take place thereafter. It is possible to immobilize the part which has been grafted or healed with scar to put the joint on full stretch till the tendency to shrink has passed. The necessary position is maintained by an accurately fitting plaster or molded splint and all joints mobilized intermittently. Established hypertrophic scars and contractures need treatment by excision, release and resurfacing by either skin grafts or flaps.
Burns are common injuries, seen and treated by members of many different branches of the medical profession: they come within the ambits of general practitioners, casualty officers, general and trauma surgeons and plastic surgeons. They are usually treated by them singly or jointly on the merit and severity of a given case and the facilities and expertise available in the area. The development of specialized centers for burns care with all infrastructure and allied specialties has resulted in decreasing the mortality and morbidity and hence should be the first choice when feasible for managing acute burns .
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