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Preventive measures for scar formation, in particular after skin grafting, include the application of splints, generally on your neck, upper extremities and hands. Immobilizing the scarred area helps soften scars. Extreme immobilization, as in burns of the neck, leads to minimized contracture.

Scar contractures

In burns, contracture usually shows when the scar line is vertical to the natural tension lines, as in scars over a joint. It should be mentioned that the primary treatment of the burn wound should actually intend to minimize scar contracture by grafting the patients as soon as possible. In some lesions 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 intervention, according to the localization, extent and form of the scar. For example, Z-plasty can reorient the scar and minimize skin tension. If on the other hand the scar contracture leads to a diminishment of the full range of movement, skin grafting or the use of a flap is indicated to hide the tissue defect.

Tissue expanders can be applied today in different shapes and volumes as a auxiliary procedure to reconstruct lesions. Tissue expansion is not recommended for a primary closure of an open wound. In severe contractions skin grafts still give as good effects as the myocutancous or fasciocutaneous axial flaps. It is up to the doctor to decide which procedure to use.

Hypertrophic scars

Hypertrophic scars are more commonly seen in burn wounds. It is medically very hard to differentiate them from keloids arising from burn wounds, although they are different pathological entities.

Hypertrophic scars always appear when the primary 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, several 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 an ordinary needle. With such a needle it is more or less impossible to apply the medicine intralesionally, because of the fibers density. The jet-apparatus has the property of having the appropriate pressure, and the moment of "firing", to insert the medicine intralesionally. It appears that the greatest advantage of the dermo-jet lies in the pressure, which causes a rupture of the irregularly woven fibers. It appears that steroids are also necessary, although it promotes a destruction of the fibers. The reaction to the treatment must be controlled after the second session, when the hyperti-lophic scar becomes softer and itching disappears. The treatment continues in sessions till the scar becomes lighter and softer. The color change is the last of the symptoms to be restored and is observed some months after the treatment is finished.