Management Of Burn Scar Contractures:

Ahmed Mohamed Anwar

SUMMARY=======The skin is an anatomically and physiologically specializedboundary lamina which is of major importance in the life of theindividual. It is composed of two layers of distinctive structure,properties and embryological origin the dermis, and the epidermiswhich cover it. Within the skin, the blood supply anddrainage along well determined pathways. The appendages of skinare nails, hairs, sebaceous glands and sweat glands.When skin is exsposed to burn the process of healing is conduciveto the formation of hypertrophic and contracted scars, asit is characterized by a marked increase in vascularity, fibroblasts,myofibroblasts, collagen deposition, interstitial material,and edema.Scar contractures and hypertrophic scar formation followingthermal injury can be markedly lessened by prop~r positioning ofthe patient, utilisation of splints to maintain good position ofall joints during acute stage and long term use of splints andpressure dressing following healing. Early surgical excision andskin grafting of fullthickness burns minimize the development ofcontractures.When scar contracture is well established and matured,surgicalcorrection is indicated. The generally accepted methods of con-93tracture release are Z-plasty and incisional release with graft.Also local, distant, island and myocutaneous flaps have beenused. When Skin flaps are raised including the deep fascia, thiswill increase the reliability and length to breadth ratios.With the advent of microvascular free-tissue transfer, burnsurgeons have begun to use this new technique to treatment ofpostburn contractures.