Burn Scar Treatment

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Burn related scar evolution leads to three possible abnormalities: Keloid, Hypertrophic and Contractures. Keloid scars are an overgrowth of scar tissue. The scar will grow beyond the site of the injury. These scars are generally red or pink and will become a dark tan over time. Hypertrophic scars are red, thick and raised, however they differ from Keloid scars in that they do not develop beyond the site of injury or incision. A contracture scar is a permanent tightening of skin that may affect the underlying muscles and tendons that limit mobility and possible damage or degeneration of the nerves

As the quality of a scar is however unpredictable, preventive measures, including the use of fatty ointments and continuous pressure, should always be taken. Splints are also useful. The treatment of the three main abnormalities is described. No method is perfect and the aim in the treatment of burn scars must therefore be the prevention of abnormalities by early excision of the primary bum wound.

The scar is the end result of wound healing in the deep partial thickness and full thickness burns. According to its pathology, scar evolution leads to the formation of three different types of abnormality:

1. scar contractures
2. hypertrophic scars
3. keloids.

The evolution of the scar depends on various factors, of which some can be altered by therapeutic measures. Others can influence the quality of the scar in a negative way, such as the site of the scar, its healing process, the age, sex and race of the patient, etc.

Nevertheless, the quality of a scar is unpredictable, especially for the first 10-15 days after its appearance. For this reason preventive measures should be undertaken in time to avoid the manifestation of an abnormal scar.

Fatty ointments penetrate easily into the scars and the surrounding normal skin. It seems that the maintenance of a fatty milieu around the scar diminishes the period of aseptic inflammation and excludes irritation by the exfoliation of the new scar.

Many observations reveal that from the preventive point of view the combination of this treatment with continuous pressure has encouraging results, especially in extended burn scars.

Pressure does not allow the formation of interstitial oedema and restricts the development of new capillaries, when applied in a range of 15-40 min Hg.

For this purpose well-known garments have been invented. They should be applied two weeks after grafting or when spontaneous healing has occurred. They should be worn for 9-12 months, all day long, until the scars become soft, flat and pale in colour. Although compression was first described by Dupuytren in 1832 there is still some controversy regarding its mode of action and even of its necessity.

Preventive measures for scar formation, especially after skin grafting, include the use of splints, particularly in the neck, the upper extremities and hands. They lead, through immobilization, to a softening of the scar. Immobilization in an extreme extension position, as in burns of the neck, leads to diminished contracture.

Scar contractures

In burns, contracture usually appears when the scar line is vertical to the skin tension lines, as in scars over a joint. It should be emphasized that the primary treatment of the burn wound should actually aim to diminish scar contracture by grafting the patients 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 scar contracture is scar revision, combined with another surgical procedure, according to the localization, extent and shape of the scar. For example, Z-plasty can redirect the scar and reduce skin tension (Fig. 4 a, b). 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 used today in different shapes and volumes as a secondary procedure to reconstruct defects. Tissue expansion is not recommended 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 method to use.

Hypertrophic scars

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

Hypertrophic scars always develop when the primary excision is delayed more than 10 days post-bum. Due to aseptic inflammation, it is not advisable to operate before the first 8 months, unless the scar causes functional disorders.

Localized scars of small extent are treated with steroid injections. The use of an air-jet apparatus ("dermo-iet") is more efficient than the injection with an ordinary needle. With such a needle it is more or less impossible to inject the medicament intralesionally, because of the fibres' density. The jet-apparatus has the property of having the appropriate pressure, and the moment of "firing", to insert the medicament intralesionally. It seems that the main advantage of the dermo-jet lies in the pressure, which causes a destruction of the irregularly woven fibres. It seems that steroids are also necessary, although it causes a destruction of the fibres. The treatment should continue in sessions till the scar becomes thinner and softer. The colour change is the last of the symptoms to be restored and is observed some months after the treatment is finished.

The surgical treatment varies depending on the extent and the site of the hypertrophic scar. Small scars can be revised and removed, the defect being covered by local or distant flaps. In extensive scars tension should be released primarily, because the scar will not soften and more importantly constant irritation may lead to the formation of precancerous lesions. The defects resulting from the relief of tension are covered by split thickness skin grafts, which in some cases are meshed.
Small and multiple hypertrophic scars should be treated by dermabrasion. The results are not very satisfactory when dermabrasion is applied to patients of darker skin, since it results in a whitish skin area.

The main aim in the treatment of burn scars is to limit their development by performing an early excision of the primary bum wound.

 

Burn Scar Treatment

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Home microdermabrasion cream. Contains the same natural ingredients in BIOSKINCARE but infused with micro-crystals so that you may rub it with your finger tips to remove old, hard, and tough scars or stretch marks by a physical breakdown of the scar tissues. Best also for oily skin and aged skin, actinic keratosis scales and pitted acne scars. Not for keloids and not if your skin is still fragile (use BIOSKINCARE for a few months first to strengthen your skin). The compounded action of the physical abrasion and the enzymes in the cream liquefy damaged proteins more thoroughly helping to release amino-acids to aid in rebuilding damaged tissues quickly. Results are not only immediate, but compound over time and do not trigger inflamm-aging of delicate skin tissues.

 

Microdermabrasion Benefits

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