Scar contractures

Scar contractures typically occur after burn injury. They are shortened (contracted), hypertrophic regions of scar. They develop in scars crossing joints or skin creases perpendicularly. Prolonged skin contractures can result in secondarily underlying soft tissue such as ligaments and muscles. The latter can be extremely difficult to treat and as such, active skin contractures should be treated aggressively.

The treatment of scar contractures usually is carried out by a multidisciplinary burns team. It can entail both splinting and physiotherapy to maintain an adequate range of motion of any affected joints, or surgical interventions which can include:

• incisional or excisional contracture release with or without skin grafting
• Z-plasty refashioning of the contracture band by interposition of local flaps from surrounding, uninvolved soft tissue
• tissue expanders - slowly filled, implanted subcutaneous balloons - to create excess skin surrounding the contracture that is then advanced once the contracture is excised
• regional or free flap coverage: moving a large composite volume of tissue to the region where a large contracture has been removed or released