Diagnosis, Assessment, and Classification of Scar Contractures

Abstract

Differential diagnosis of ankylosis or contracture is important (Fig. 8.1). Ankylosis is a stiffness of a joint, and can vary from moderate to severe. Ankylosis may involve the deeper tissues, including bone, cartilage, and joint capsule and may require orthopedic surgical release. In soft tissue contractures, myogenic and neurogenic contractures should be excluded for surgical reconstruction. In connective tissue contracture, differential diagnosis by anatomical structures should be performed before the planning of surgical methods. Connective tissue contractures can be classified by affected tissues (Fig. 8.1); (a) Cutaneous, subcutaneous or fascial contracture, (b) Tendon contracture, (c) Ligament contracture and (d) Muscle contracture. Many of burn scar contractures are classified into cutaneous/subcutaneous contracture. If tendon, ligament, and muscle contracture were diagnosed, these replacement/reconstruction methods should be considered in addition to releasing scar contractures.