Cosmetic Surgery - Burn Scar

The late appearance of scars after burns in childhood.

• Zeitlin R,
• Jarnberg J,
• Somppi E,
• Sundell B.

Department of Paediatric Surgery, Tampere University Hospital, Finland.

The late appearance of scars in children who had been burned, mainly scalded (n = 82, 90%) were analysed retrospectively from patient records and by clinical reassessment. All 91 patients who were re-examined had primarily sustained a burn of at least 5% of their total body surface area (TBSA). Only five patients showed no visible scars. The median interval between primary injury and re-examination was 17.3 years (range 6.4-30 years). Less than half of the patients (n = 36, 40%) had distinct scars without hypertrophy. The remaining 55 (60%) had either hypertrophic or constrictive scars. The scars were mostly located on the trunk (29%) and looked mainly hypertrophic (30.2%). The mean area of scars varied from 0.47% (on the neck) to 3.73% (on the left lower limb). There was no significant association between the appearance of the scar and any given method of treatment. The late cosmetic results were better than anticipated.

Burns

Preventing Scars and Contractures

Preventing scars after a burn:

Scars are thickened marks left after a burn has healed. Most second and third degree burns cause some degree of scarring. Physical therapists will work with your child to prevent or reduce scarring.

Wearing pressure garments can minimize scarring. Children with deeper burns need pressure garments. Pressure garments are tight-fitting clothes to be worn over burned areas to prevent scarring. These must be worn 23 hours per day (taken off only for bathing) for up to two years after the burn.

Your child should have at least two sets of pressure garments, so one can be worn at all times while the other pair is being washed. You should hand wash the pressure garment, rinse, squeeze gently on a towel, and hang to dry. Do not use bleach or put the pressure garment in the dryer, because this will damage the garment. As your child grows, he/she many need to have new, larger garments.

Preventing contractures after a burn:

Contractures occur when the burn scar matures, thickens, and tightens, preventing movement. A contracture is a serious complication of a burn. If your child gets a contracture, he/she will not be able to move the scarred area normally. For example, your child may have difficulty doing normal things like dressing, walking, eating, or playing - depending on where the scar contracture is located. It is important that you let your child do things for himself/herself regardless of how long or hard it might be for them. This will help prevent contractures and help your child become independent and confident.

Most second and third-degree burns do cause some degree of scarring, but there are several things that can be done to minimize scarring and to prevent contractures, including the following:

• wearing a splint
  Sometimes, after a child has been burned, he/she will need to wear a splint on the joint to keep it straight and to help prevent a contracture. Splints should be worn on top of the pressure garment.
• practicing range of motion exercises
  Range of motion (ROM) exercises help keep the muscles and joints of the burned limbs flexible. A physical therapist (PT) will teach you and your child how to do ROM, so you can help in the healing process.
• exercising
  Do the special exercises given by your child's physical therapist with your child faithfully. Exercises are very important to keep the scar area stretched and prevent a thick, hard, tight contracture. Exercises must be done even if your child does not like them. You may want to reward your child for doing a good job at the end of the exercises.
• promoting independence
  Have your child do daily activities for himself/herself, as much as possible. For example, let your child eat, brush teeth, brush hair, and dress. Even if it is a little difficult for your child, let him/her do these activities and overcome the temptation to help. The movement that occurs during daily activities will help keep the scar area stretched. Your child should perform daily range of motion exercises as directed by the physical therapist or your child's physician.

 

 

Scars From Burns

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