Burns, Scars & Contractures
Burns, Scars & Contractures
Injuries such as burns that involve damage to the dermis rarely heal without formation of a scar. Scar tissue is not identical to the tissue that it replaces and is usually more fibrous and of inferior functional quality. The scar shows an increase in the thickness of the new epithelial layer but the attachment of epidermis is poor making the surface vulnerable to further injury. Sometimes the scarred skin extends beyond the three-dimensional boundary of the original tissue resulting in a raised or hypertrophic scar. Hypertrophic scarring is seen in up to 50% of healed deep burns and this can lead to wound contracture if the scar affects a joint as the skin over the joint is firmer and less extensible and this in turn then limits movement of the joint.
Both the contracture and hypertrophic scarring process peak between 3 and 6 months after injury and partially resolve at 12 to 18 months, frequently long after the patient has been discharged.
Restrictive contractures due to serious burn injuries can result in long term aesthetic (Cosmetic) and physical consequences. Skin contractures bridging or located proximal to a joint lead to joint deformities that severely restrict range of motion (ROM) of the effected joint. Skin contractures are also often accompanied by debilitating levels of chronic pain requiring a high dependency on pain medication. This pain medication can also lead to other undesirable side-effects and unwanted dependency on the drugs administered to control the pain. These factors in isolation or combined can lead to significant disruption in both social and professional life, leading to a marked impact on the quality of life.
Post-burn contractures are therefore a very significant problem for the injured problem and that any treatment that can alleviate this problem will be of tremendous benefit. Moreover, extensive traumatic skin loss and resulting contractures also occurs with other battlefield injuries that do not necessarily involve thermal burns and is particularly an issue with Improvise Explosive Devices (IEDs). The current standard of care for a wound contracture involves surgical release or excision of the contracture itself and skin grafting which requires extensive and often repeated surgeries. Use of full thickness skin grafts, local flaps are used to correct the deformities.
