Skip to main content
SpringerLink
Log in

Burn Scar and Contracture Management

  • Chapter
  • First Online:
Essential Burn Care for Non-Burn Specialists

  • 306 Accesses

Abstract

Burns are wounds of the tissue architecture caused predominantly by thermal, electrical, or chemical injury. Their severity depends on the total body surface area involved and on the depth of the damage to the skin and underlying deep structures. Superficial injuries harbour the potential for self-regeneration due to the integrity of epidermal appendages within a preserved dermis.

Deeper injuries destroy the ability of the tissues to heal by themselves due to loss of dermal integrity and blood supply. The direct consequences of deep burn injury or delayed healing are the formation of burn scars and contractures. These can cause severe functional deficit and cosmetic embarrassment that greatly affect the patient’s quality of life both physically and psychologically.

In this chapter, we will be describing the abnormal features of burn scarring concerning the patient that need to be recognised and that may require appropriate assessment and management from the non-burn specialist.

If the scars or contractures are complex or exceeding resources available, they may warrant appropriate referral to burn specialists within an expert and multidisciplinary scar management environment. The various choices for scar improvement will need to be tailored to the presenting physical or psychological concerns of the patient in a targeted consultation that evaluates the need for further escalation.

The different options available for scar management that can guide the non-burn specialist to inform the patients and if necessary, refer them will be explained. These include multiple evidence-based alternatives in ascending order of complexity that range from basic skin-care practices, the use of modern technology, and light therapies such as laser to the most interventional treatments such as surgical reconstruction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 79.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Monstrey S, Hoeksema H, Verbelen J, Pirayesh A, Blondeel P. Assessment of burn depth and burn wound healing potential. Burns. 2008;34(6):761–9.

    Article  PubMed  Google Scholar 

  2. Tan HMG, Chung L, Chong XY, Joethy J, Chong SJ. A simple mnemonic, B.U.R.N.S., for burns first aid. Burns. 2022;48(4):841–5. https://doi.org/10.1016/j.burns.2021.11.013.

    Article  PubMed  Google Scholar 

  3. Djärv T, Douma M, PalmierI T, et al. Duration of cooling with water for thermal burns as a first aid intervention: a systematic review. Burns. 2022;48(2):251–62. https://doi.org/10.1016/j.burns.2021.10.007.

    Article  PubMed  Google Scholar 

  4. Griffin BR, Frear CC, Babl F. Cool running water first aid decreases skin grafting requirements in pediatric burns: a cohort study of two thousand four hundred ninety-five children. Ann Emerg Med. 2021;75(1):75–85.

    Article  Google Scholar 

  5. Jackson DM. The diagnosis of the depth of burning. Br J Surg. 1953;40:588–96.

    Article  CAS  PubMed  Google Scholar 

  6. Finlay V, Burrows S, Burmaz M, et al. Increased burn healing time is associated with higher Vancouver Scar Scale score. Scars Burns Healing. 2017;3:1–10.

    Article  Google Scholar 

  7. Cubison TCS, Pape SA, Parkhouse N. Evidence for the link between healing time and the development of hypertrophic scars (HTS) in paediatric burns due to scald injury. Burns. 2006;32(8):992–9.

    Article  PubMed  Google Scholar 

  8. Win TS, Nizamoglu M, Maharaj R, et al. Relationship between multidisciplinary critical care and burn patients survival: a propensity-matched national cohort analysis. Burns. 2018;44(1):57–64.

    Article  PubMed  Google Scholar 

  9. Song M, Armstrong A, Murray A. Acid attacks: broadening the multidisciplinary team to improve outcomes. Burns. 2020;46(3):514–9.

    Article  PubMed  Google Scholar 

  10. Edmondson SJ, Ali Jumabhoy I, Murray A. Time to start putting down the knife: a systematic review of burns excision tools of randomised and non-randomised trials. Burns. 2018;44(7):1721–173.

    Article  PubMed  Google Scholar 

  11. Strassle PD, Williams FN, Napravnik S, van Duin D, Weber DJ, Charles A, Cairns BA, Jones SW. Improved survival of patients with extensive burns: trends in patient characteristics and mortality among burn patients in a tertiary care burn facility, 2004–2013. J Burn Care Res. 2017;38(3):187–93.

    Article  PubMed  Google Scholar 

  12. Latenser B. Critical care of the burn patient: the first 48 hours. Crit Care Med. 2009;37:2819–26. https://doi.org/10.1097/CCM.0b013e3181b3a08f.

    Article  CAS  PubMed  Google Scholar 

  13. Baumann ME, DeBruler DM, Blackstone BN, et al. Direct comparison of reproducibility and reliability in quantitative assessments of burn scar properties. Burns. 2021;47(2):466–78.

    Article  PubMed  Google Scholar 

  14. Finnerty C, Jeschke M, Branski L, Barret J, Dziewulski P, Herndon D. Hypertrophic scarring: the greatest unmet challenge after burn injury. Lancet. 2016;388:1427–36.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Greenhalgh D. Consequences of excessive scar formation: dealing with the problem and aiming for the future. Wound Repair Regen. 2007;15:52–5.

    Article  Google Scholar 

  16. Maskell J, Newcombe P, Martin G, et al. Psychosocial functioning differences in pediatric burn survivors compared with healthy norms. J Burn Care Res. 2013;34(4):465–76.

    Article  PubMed  Google Scholar 

  17. Brewin MP, Homer SJ. The lived experience and quality of life with burn scarring—The results from a large-scale online survey. Burns. 2018;44(7):1801–10.

    Article  CAS  PubMed  Google Scholar 

  18. Jabeen S, Clough ECS, Thomlinson AM, Chadwick SL, et al. Partial thickness wound: does mechanism of injury influence healing? Burns. 2019;45(3):531–42.

    Article  PubMed  Google Scholar 

  19. Visscher MO, Bailey JK, Hom DB. Scar treatment variations by skin type. Facial Plast Surg Clin North Am. 2014;22:453–62.

    Article  PubMed  Google Scholar 

  20. Brusselaers N, Pirayesh A, Hoeksema H, Verbelen J, Blot S, Monstrey S. Burn scar assessment: a systematic review of objective scar assessment tools. Burns. 2010;36(8):1157–64.

    Article  PubMed  Google Scholar 

  21. Baumann ME, DeBruler DM, Blackstone BN, Coffey RA, Boyce ST, Supp DM, Bailey JK, Powell HM. Direct comparison of reproducibility and reliability in quantitative assessments of burn scar properties. Burns. 2021;47(2):466–78.

    Article  PubMed  Google Scholar 

  22. Lye I, Edgar DW, Wood FM, Carroll S. Tissue tonometry is a simple, objective measure for pliability of burn scar: is it reliable? J Burn Care Res. 2006;27(1):82–5.

    Article  PubMed  Google Scholar 

  23. van der Wal M, Bloemen M, Verhaegen P, Tuinebreijer W, de Vet H, van Zuijlen P, Middelkoop E. Objective color measurements: clinimetric performance of three devices on normal skin and scar tissue. J Burn Care Res. 2013;34(3):e187–94.

    Article  PubMed  Google Scholar 

  24. Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ. Rating the burn scar. J Burn Care Rehabil. 1990;11(3):256–60.

    Article  CAS  PubMed  Google Scholar 

  25. Draaijers LJ, Tempelman FR, Botman YA, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg. 2004;113(7):1960–5; discussion 1966–1967.

    Article  PubMed  Google Scholar 

  26. Yeong EK, Mann R, Engrav LH, et al. Improved burn scar assessment with use of a new scar-rating scale. J Burn Care Rehabil. 1997;18(4):353–5; discussion 352.

    Article  CAS  PubMed  Google Scholar 

  27. Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MW. A new quantitative scale for clinical scar assessment. Plast Reconstr Surg. 1998;102(6):1954–61.

    Article  CAS  PubMed  Google Scholar 

  28. Tyack Z, Simons M, Spinks A, Wasiak J. A systematic review of the quality of burn scar rating scales for clinical and research use. Burns. 2012;38(1):6–18.

    Article  PubMed  Google Scholar 

  29. Mustoe TA, Cooter R, Gold M, et al. International clinical guidelines for scar management. Plast Reconstr Surg. 2002;110:560–72.

    Article  PubMed  Google Scholar 

  30. Huang C, Murphy GF, Akaishi S, et al. Keloids and hypertrophic scars: update and future directions. Plast Reconstr Surg Glob Open. 2013;1:e25.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bombaro KM, Engrav LH, Carrougher GJ, Wiechman SA, Faucher L, Costa BA, et al. What is the prevalence of hypertrophic scarring following burns. Burns. 2003;29(4):299–302.

    Article  PubMed  Google Scholar 

  32. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg. 2022;149(1):79e–94e.

    Article  CAS  PubMed  Google Scholar 

  33. Ault P, Plaza A, Paratz J. Scar massage for hypertrophic burns scarring—a systematic review. Burns. 2018;44:24–38.

    Article  CAS  PubMed  Google Scholar 

  34. Shin TM, Bordeaux JS. The role of massage in scar management: a literature review. Dermatol Surg. 2012;38:414–23.

    Article  CAS  PubMed  Google Scholar 

  35. Valladares-Poveda S, Avendaño-Leal O, Castillo-Hidalgo H, et al. A comparison of two scar massage protocols in pediatric burn survivors. Burns. 2020;46(8):1867–74.

    Article  PubMed  Google Scholar 

  36. De Decker I, Hoeksema H, Verbelen J, et al. The use of fluid silicone gels in the prevention and treatment of hypertrophic scars: a systematic review and meta-analysis. Burns. 2022;48(3):491–509.

    Article  PubMed  Google Scholar 

  37. Bleasdale B, Finnegan S, Murray K, et al. The use of silicone adhesives for scar reduction. Adv Wound Care (New Rochelle). 2015;4:422–30.

    Article  PubMed  Google Scholar 

  38. Zhuang ZH, Li YT, Wei XJ. The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: a systematic review and meta-analysis. Burns. 2021;47(5):987–98.

    Article  PubMed  Google Scholar 

  39. Bao Y, Xu S, Pan Z, Deng J, Li X, Pan F, et al. Comparative efficacy and safety of common therapies in keloids and hypertrophic scars: a systematic review and meta-analysis. Aesthet Plast Surg. 2020;44(1):207–18.

    Article  Google Scholar 

  40. Shaarawy E, Hegazy RA, Abdel Hay RM. Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial. J Cosmet Dermatol. 2015;14(2):161–6.

    Article  PubMed  Google Scholar 

  41. Hewedy ES, Sabaa BEI, Mohamed WS, Hegab DS. Combined intralesional triamcinolone acetonide and platelet rich plasma versus intralesional triamcinolone acetonide alone in treatment of keloids. J Dermatolog Treat. 2022;33(1):150–6.

    Article  CAS  PubMed  Google Scholar 

  42. España A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001;27(1):23–7.

    PubMed  Google Scholar 

  43. Kondo A, Toyohara E, Sakae Y, Noda Y, Ogawa R. 341 effectiveness of corticosteroid tapes for hypertrophic scars and keloids. J Burn Care Res. 2019;40(Supplement_1):S147–8.

    Article  Google Scholar 

  44. Willows BM, Ilyas M, Sharma A. Laser in the management of burn scars. Burns. 2017;43(7):1379–89.

    Article  PubMed  Google Scholar 

  45. Issler-Fisher AC, Fisher OM, Clayton NA, et al. Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures, hospital admission patterns as well as length of stay. Burns. 2020;46(1):65–74.

    Article  PubMed  Google Scholar 

  46. Azzopardi EA, Duncan RT, Kearns M, et al. Cutaneous laser surgery for secondary burn reconstruction: cost benefit analysis. Burns. 2020;46(3):561–6.

    Article  PubMed  Google Scholar 

  47. Peng W, Zhang X, Kong X, Shi K. The efficacy and safety of fractional CO2 laser therapy in the treatment of burn scars: a meta-analysis. Burns. 2021;47(7):1469–77.

    Article  PubMed  Google Scholar 

  48. Hultman S, Edkins R. Pulsed dye laser photothermolysis versus fractional CO2 laser ablation for the treatment of hypertrophic burn scars: results from a large, rater-blinded, before-after cohort study. J Burn Care Res. 2019;40(Supplement_1):S37–8.

    Article  Google Scholar 

  49. Bernabe R, Calero T, Lin J, et al. Laser-assisted drug delivery in the treatment of hypertrophic and keloid scars: a systematic review. J Burn Care Res. 2022;43(Supplement_1):S103–4.

    Article  PubMed Central  Google Scholar 

  50. Alster TS, Li MKY. Microneedling of scars: a large prospective study with long-term follow-up. Plast Reconstr Surg. 2020;145(2):358–64. https://doi.org/10.1097/PRS.0000000000006462. Erratum in: Plast Reconstr Surg. 2020 May;145(5):1341.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic Surgery and Burns, Chelsea and Westminster Hospital, London, UK

    Jorge Leon-Villapalos, David Zergaran & Tom Calderbank

Authors
  1. Jorge Leon-Villapalos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Zergaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tom Calderbank
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jorge Leon-Villapalos .

Editor information

Editors and Affiliations

  1. Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA

    Jong O. Lee

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Leon-Villapalos, J., Zergaran, D., Calderbank, T. (2023). Burn Scar and Contracture Management. In: Lee, J.O. (eds) Essential Burn Care for Non-Burn Specialists. Springer, Cham. https://doi.org/10.1007/978-3-031-28898-2_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-28898-2_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-28897-5

  • Online ISBN: 978-3-031-28898-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation