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Preventive measures for scar development, in particular after skin grafting, include the use of splints, generally on your neck, arms and hands. These measures should be combined with immobilization to soften scarring. Extreme immobilization, as in burns of the neck, leads to diminished contracture.

Scar contractures

In burns, contracture commonly shows when the scar line is vertical to the natural tension lines, as in scars over a joint. It should be emphasized that the primary treatment of the burn wound should actually intend to minimize scar contracture by grafting the sufferers as soon as possible. In some cases pediele flaps or even free flaps can be used primarily to cover the defect and prevent contracture.

The treatment of choice for scarring contracture is scar revision, along with another surgical intervention, according to the place, 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 restriction of the full range of motion, skin grafting or the use of a flap is indicated to cover the tissue defect.

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

Hypertrophic scars

Hypertrophic scars are more usually seen in burn injuries. It is medically very difficult to differentiate them from keloids arising from burn injuries, although they are different pathological alterations.

Hypertrophic scars always appear when the main excision is delayed more than ten days post-burn. Due to aseptic inflammation, it is not advisable to operate before the first eight months, unless the scar causes functional troubles. Meanwhile, several conservative measures can be applied, depending on the scar extent.

Localized scars of small extent are commonly treated with steroid injections. The use of an air-jet apparatus ("dermo-iet") is more efficient than the injection with a simple needle. With such a needle it is more or less impossible to inject the medication intralesionally, because of the tissues density. The jet-apparatus has the property of having the appropriate pressure, and the moment of "firing", to apply the medicine intralesionally. It seems that the main advantage of the dermo-jet lies in the pressure, which causes a rupture of the irregularly woven fibers. It seems that steroids are also needed, although it causes a destruction of the fibers. The reaction to the treatment should be controlled after the second session, when the hyperti-lophic scar becomes softer and itching recedes. The treatment continues in sessions till the scar becomes thinner and softer. The color variation is the last of the symptoms to be recovered and is observed some months after the treatment is finished.

A new skin care treatment offers the chance to get rid of scars, blemishes and other skin imperfections, while at the same time protects you skin and keeps its hydration.