Correction of Burn Deformities
Burns heal by the growth and replacement of burned layers of skin with scar tissues. The tissues in the wound start to dry up and contract forming Contractures. A contracture may cause restriction of movement, if present on a joint or it may lead to disfigurement of the affected part due to pull on the surrounding tissues. The burnt tissue usually undergoes a period of maturation and remodeling in the next 12 to 18 months. Burns may lead to the deformities:
KELIOD AND HYPERTROPHIC SCARS.
Hypertrophic scars and keloids are difficult to improve and remain a therapeutic challenge. Every time the skin is cut or injured it will heal with a scar. Some people make better scars than others. In general patients with black and pigmented skin will tend to produce poor scars including keloids and hypertrophic scars .Certain areas of the body are known to produce keloid scars than others. The worst areas are the chest, shoulders and over bony prominences, but fortunately the face and neck produce good scars .Scars which lie in the lines of skin tension are better than ones that run across them. Prevention is the foremost in keloid therapy. Avoid performing unwanted cosmetic surgeries in patients known to form keloids. Suture all surgical wounds with minimal tension. Incisions should not cross joints and avoid making chest incisions, and make sure that incisions follow skin creases whenever possible. Treatments include Intralesional Steroid injections, occlusive dressings, and compression therapy,. Intralesional steroid injections have been the mainstay of treatment.Intralesional steroids reduce excessive scarring by reducing collagen synthesis. The most commonly used steroid injection is Triamcinolone acetonide (TAC) in concentrations of 10-40 mg/ml, given intralesionally into the scar with 25- to 27-gauge needles at 6-week intervals. Other measures include occlusive silicon sheets on top of these scars. They are used for periods of 3- 6 months. Compression therapy with pressure garments is also very effective.
Compression treatments also include button compression, pressure earrings, elastic adhesive bandages, compression wraps, and support bandages. Compression therapy involves pressure, which has thinning effect on skin.Intense Pulse Light ( IPL) laser when used along with intra lesional steroids can produce a marked improvement in the scar texture , colour improvement and reduction in scar height.
BURN DEFORMITIES & CONTRACTURES –
Contractures occur when a healing thick burns scar pulls on the edges of the skin making a tight band. These contractures can produce restriction of movements and can affect the muscles, joints, and tendons. Contractures that occur after burns and are referred to as Post Burn Contractures (PBC).
SURGICAL CORRECTION OF POST BURN DEFORMITIES :-
Skin Grafting – The procedure of skin grafting involves replacing the damaged area of the skin by a sheet of skin taken from healthy area of the body..
Skin Flap Surgery – Flap surgery is a procedure in which skin, along with the underlying subcutaneous tissues ,, blood vessels, and at times the muscle, is moved from a healthy part of the body to the injured site.
Z – Plasty –In this scar revision procedure, a Z-shaped incision is used. Z – Plasty is used to release the tight band in case of a contracture. This procedure also helps to realign and blend the scar in the natural creases and folds of the surrounding skin.
Tissue Expansion – The technique of tissue expansion is used sometimes along with skin flap surgery. In this technique the amount of existing tissue is expanded/increased for re-constructive purposes.