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General consideration for treatment of burn contractures.

Nothing is more painful than a burn of the skin – large or small. The raw skin uncovered when the injured skin peels off opens nerve endings that are constantly traumatized by air, clothing, and water. A simple 2nd degree burn will take 2-3 weeks to heal. Daily dressing changes to cleanse the skin of bacteria are a necessary but painful part of the healing regimen. Even after they heal, burns scars of the skin often leave a pigmentation (colour) change on the skin along with a texture change. This makes a burn injury very noticeable when you meet a survivor of a burn injury. The skin is often red and itchy and may not stretch or move in a normal way. Very deep burns (3rd degree) can destroy underlying tendons and muscles, which further impair function. Scars are in this painful, itchy state for up to two years after an injury. Sun, chemicals and heat exposure all contribute to the continued pain post burn.

Over time the redness may fade but the scar never truly resolves. This constant visual reminder of the trauma and pain of the injury can leave psychological scars on the soul. Patients who are lucky to have family to talk to, loved ones to heal with may learn to accept their new skin texture and colour. But many people who are burned will never learn to accept their changed appearance. They will always long to return to the ‘normal’ skin they had before injury. To help with this sense of loss, the Plastic Surgeon tries to remove as much of the scar skin as possible, and where it cannot be removed to at least change the shape and the colour to return the appearance closer to normal, to improve the motion and the function of the scar and to give the patient more freedom from painful scars. Sometimes simple surgeries are very effective at improving a scar. This new sense of hope will help many burn survivors re-integrate with their friends and allow them to once again participate in community activities.

Patient shortly before being operated.

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