Post Burn Contractures

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If you have ever burned your skin, even a little bit, you must have known how much it hurts! But by burn scar contracture, we do not mean ONLY a burned skin but the severely painful skin tightening that the patient experiences usually in a case of 2nd or 3rd burn degrees. A contracture is a grave problem a burn patient can face.
Why? Because with time and if left untreated, it will only worsen the condition by restricting the motion range and mobility. For instance, the patient will start having trouble performing normal daily tasks such as dressing, eating, or walking.

 What is the contracture?

The contracture occurs as a consequence of certain severe wounds particularly after burn contracture scars that need special attention. The contracture is a process that starts from the burn scar being matured, then the scar thickens, and at the end, it tightens as the surrounding skin is pulled together and causes pain. You can typically see it in the cases of the burn over a joint means joint contracture.

If you are thinking it cannot relapse, you are wrong because recurrence of post-burn contracture is the most frequently experienced complication of burn scar contracture.As far as the difficulty and commonality are concerned, contractures of the webspace, hand, and digits are on the top of the list. For the treatment of the webspace post-burn contractures and post-burn syndactyly, scar excision and skin grafting are the ideal options.

Why is Physiotherapy important?

  • Help maintain the ROM for the joints and muscles of the burned limb
  • Minimizes the possibility of contracture development
  • The impact of scarring is decreased
  • Movement helps prevent the severe deformity
  • Improve the emotional and mental well-being of the patient
  • Maximizes the social interaction and brings back to normal social life
  • The functional ability is retained
  • The recovery time is quickened
  • The QOL (quality of life) seems to get better

 Treatments for the Post-burn contractures

Like we said earlier, it is a serious complication and needs to be treated without any delay. Post-Burn contractures will never be resolved or get better on their own. Well, it might be improved over an extended period. The person must practice following the guidelines provided by the occupational therapist and physiotherapist. Besides the splinter is an advantageous option to minimize the risk factors. But, regrettably, if the wound seems persistent, the contracture might need to be surgically treated.

  • The usually safe and preferable technique is the local skin flaps (z-plasty) which are also known as skin grafting.
  • Apart from the grafting, pharmacy, and drug-store burn treatment is also enlisted secure and effective. At the top of the list comes the silicone gel treatments.
  • Now, comes the carbon dioxide laser therapy which helps the surrounding skin contracture of the scar to loosen up.

 Possible ways of preventing post-burn contractures 

 Take help from a splint 

This could be the most feasible and assured way to prevent the contractures. A child with a burn scar should wear a splint over the joint. The aim is to keep the burned part in a stretched position. Try wearing splints on the top of the pressure clothing. Keeping the scar extended will avoid the possibility of contracture.

 Performing ROM exercises

If you are performing the Range of motion (ROM) exercises on a daily basis, your muscles and joints will be flexible enough to avoid the pulling of the burned skin. It helps you in the healing process. The patient must perform it multiple times a day. It should be performed under the supervision of an experienced physical therapist (PT) as he will decide what types of exercises you need. For instance, for the neck burn, the hyperextension of the neck is a recommended exercise that could be done by using no pillows.

 Special exercises

If you really want to quicken the healing process, exercises should never be missed. They play a very important role in keeping your scar area relaxed, stretched, and flexible consequently preventing the skin to get thick, hard, and tight forming a painful contracture. As per the location of the burn, special exercises are given. Undoubtedly, there would be severe pain but if it starts affecting the child’s capability to exercise, you must consult a health care provider, instantly.

 Promoting independence

You need to encourage the child to complete his/her tasks himself/herself. The movement happening while the child is doing daily chores is considered exceptionally helpful in keeping the scar area straightened.

Surgical management 

No surgical procedure must be carried out in the active phases of healing and scarring. It is safe to perform surgery only if the scar is no more immature and is not highly vascular. For surgery, it must be matured to limit the complication of blood loss. Only soft, mature, supple, and avascular burn scars can be treated as they will lower the risk of poor graft take by the patient leading to improper or slow healing.
Now the question is how long will it take? The answer is a minimum of ONE YEAR!
Apart from the blood loss problem, another reason to choose physiotherapy over surgery is that the immature scars are more amenable to physical therapy measures.
The surgical post-burn contracture treatment of is based on the following steps:

 Release of contracture

The aim should be the complete release of post-burn contracture in a single go. It is carried out without damaging any other important underlying body structure or vessel network. It is usually released with an incision instead of an excision to make the treatment more effective.

 Provision of skin burn cover

Once the complete release of contracture is done, a skin grafts or skin flap is applied to cover the recreated defect. It is a better practice to cover all the raw areas with skin grafts. Whereas, the use of the flap covers is recommended only during special medical scenarios. Be careful of the expanding of the sheet grafts by meshing! The skin cover can only be delayed if the wound is oozing pus and is severely infected. There are two types full-thickness grafts and split-skin grafts. Full-thickness is observed to act better as the split skin grafting can have a problem of a poor graft take.

Well, if the patient has come to you with recurrent contractures, a split-thickness skin graft is an ideal choice.