Early reconstruction of the burn contractures and sequels

Abstract

The goal of burn reconstruction should be to preserve, restore, maintain function, and improve appearance so the patient can be reinserted to society. The major problem after burn is hypertrophic scar and contractures. Prevention starts early during the acute phase of the injury and continues to the rehabilitation period. Early excision and grafting improves skin quality and decreases scar hypertrophic formation. The use of splints, pressure garment and rehabilitation may help to prevent contractures. Burn contractures are tight and are due to a shortened scar that limits joint movement. Burn contracture needs to be released in several important areas of the body. Surgical procedures were performed in the acute phase to correct ectropion, microstomia, and to release burn scar contractures in the neck, axilla, and hand. Surgeries began 6 to 12 months after discharge and the purpose was to decrease hypertrophic scar and release contractures. Ablative fractional CO2 laser has revolutionized the scar treatment, decreasing the thickness of the scar, and improving mobility in the patients. We review the surgical procedures performed by plastic and reconstructive surgery during the acute and post-acute burn phase.