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Burn Injuries Treatment

Preventive measures for scar development, in particular after skin grafting, include the use of splints, particularly on your neck, arms and hands. Immobilizing the scarred area helps soften scars. 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 skin tension lines, as in scars over a joint. It should be mentioned that the primary treatment of the burn injury should actually intend 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, along with another surgical procedure, according to the localization, extent and shape of the scar. For example, Z-plasty can redirect the scar and minimize skin tension. If on the other hand the scar contracture produces a diminishment of the full range of movement, skin grafting or the use of a flap is indicated to cover the tissue defect.
Tissue expanders can be applied today in several shapes and volumes as a auxiliary procedure to reconstruct defects. Tissue expansion is not recommended for a primary closure of an open injury. In severe contractions skin grafts still produce as good effects as the myocutancous or fasciocutaneous axial flaps. It is up to the doctor to decide which procedure to use.
Hypertrophic scars
Hypertrophic scars are more commonly seen in burn wounds. It is medically very difficult to differentiate them from keloids arising from burn wounds, although they are different pathological alterations.
Hypertrophic scars always develop when the main excision is delayed more than 10 days post-burn. Due to aseptic inflammation, it is not advisable to operate before the first 8 months, unless the scar causes functional troubles. Meanwhile, various conservative measures can be applied, depending on the scar extent.
Localized scars of small extent are commonly minimized with steroid injections. The use of an air-jet apparatus ("dermo-iet") is more effective than the injection with an ordinary needle. With such a needle it is more or less unlikely to inject the medication intralesionally, because of the fibers density. The jet-apparatus has the ability of having the appropriate pressure, and the moment of "firing", to insert the medicine intralesionally. It seems that the main advantage of the dermo-jet lies in the pressure, which inflicts a rupture of the irregularly woven fibers. It seems that steroids are also necessary, although it promotes a destruction of the fibers. The response to the treatment must be controlled after the second session, when the hyperti-lophic scar appears softer and itching disappears. The treatment continues in sessions till the scar appears lighter and softer. The color variation is the last of the symptoms to be recovered and is observed some months after the treatment is finished.
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