Scar Contracture Research Articles

Staged Periorbital Reconstruction for Cicatricial Lagophthalmos

Introduction: Eyelid trauma can present reconstructive challenges for facial surgeons. The authors postulated that treating cicatricial lagophthalmos with protective ptosis in the acute setting prior to definitive grafting could help limit scar contraction. Material and Methods: This is an observation of a patient who benefited from a staged approach to periorbital reconstruction after suffering extensive facial trauma. Informed consent was appropriately obtained from the patient. Results: After treating the periorbital injury in staged fashion, an aesthetically acceptable result was achieved and was well-tolerated by the patient. Discussion: Disruption of the periorbital region, particularly the eyelids, can have severe functional and aesthetic consequences. One such disruption is lagophthalmos. Neurotoxin-induced protective ptosis is a well-known strategy that can be used as the initial treatment in a staged approach to cicatricial lagophthalmos. Conclusion: Treating lagophthalmos with protective ptosis in the acute setting prior to definitive grafting is not only a means of avoiding tarsorrhaphy but also it can allow time for the wound to declare itself and limit scar contraction. In addition, the contralateral eyelid represents both a complimentary skin graft harvest site as well as an opportunity to create a symmetrical repair.

Graftless Syndactyly Release.

Syndactyly release aims to address skin deficits by resurfacing web spaces and sides of digits to allow independent digital motion while minimizing the risk of web creep and scar contractures. Conventional methods include the use of a dorsal and interdigitating flaps with full-thickness skin grafts. More recently, there have been several descriptions of "graftless" syndactyly release without skin grafts, thus avoiding a further (usually distant) donor site. However, the indications of when and when not to use these techniques remain unclear. In addition, the inevitable scarring from extra recruitment of local adjacent skin is perhaps underemphasized. In this article, we revisit the trilobed flap technique which serves to balance the amount of skin needed for resurfacing digits while minimizing local donor site scarring. The geometry and nuances of the flap inset are illustrated in detail to guide those embarking on this technique. The trilobed syndactyly release technique is a reproducible, safe, and reliable method for the release of simple syndactyly.

Reverse circumcision foreskin advancement flap for reconstructing penile shaft skin defects in adults with burn injuries in the perineal region

AimGenital burns are rare injuries. Reconstruction of penile skin defects should consider cosmetic and functional outcomes. Skin grafts can develop scar contractures and carry hair follicles, causing unwanted results. These downsides remain unsolved issues. This work aimed to describe a new foreskin advancement flap method for completely reconstructing penile shaft skin defects in severely burned patients. Materials and methodsFrom 2021 to 2023, four patients with third-degree burns in the genital area were enrolled in this investigation. We describe a series of cases with deep burns to the penile shaft and surrounding area that needed debridement and reconstruction using a novel technique called “reverse circumcision,” which consists of tangential excision of the penis and a foreskin advancement flap without longitudinal cuts with less morbidity, preservation of function, and a better aesthetic appearance. The patients had an average follow-up of nine months. ResultsThe reverse circumcision technique was established for patients with severe burns in the genital area. The four patients were satisfied with the postoperative results and the aesthetic results of the procedure without reporting any complications. No scarring or contractures were observed on the glans or penile shaft after surgery. ConclusionsCompared with other flap methods, the use of a reverse circumcision foreskin advancement flap was more straightforward, feasible, and effective. In adults, the foreskin tissue completely covers the penile shaft skin defect. It is a viable reconstructive surgical technique that is easily reproducible and has excellent aesthetic and functional results. For this surgical technique, tissue transfers, bulky regional flaps, or skin grafts were not needed.

Unusual cell-cell cooperative mechanical activity elucidates the process of tissue regeneration

We have studied wound contraction in three model wounds in animals: excised skin (guinea pig), transected peripheral nerve (rat) and the excised conjunctiva (rabbit). Wound contraction is driven by myofibroblasts bound together by adherens junctions (AJ) that confer cooperative activity to myofibroblasts during wound contraction and synthesis of scar. Grafting with the dermis regeneration template (DRT) cancels cell cooperativity by abolishing AJ connections in myofibroblasts, while also cancelling wound contraction, preventing synthesis of scar and inducing regeneration of excised tissues. The observed definitive prevention of scar synthesis suggests the exploration of DRT scaffolds to regenerate tissues in several other organs and to prevent fibrosis in humans.

Prosthetic Rehabilitation of a Maxillectomy Patient with Restricted Mouth Opening Using an Altered Cast Technique: A Case Report

Deformity in the maxillofacial region caused by surgical resection of a tumor have an adverse effect on the patient's ability to swallow, masticate, phonate, and psychological state. These patients may have restricted mouth opening capacity due to several surgical procedures and scar contracture resulting from radiation therapy. Therefore due to restricted access to the oral cavity prosthetic rehabilitation of these patients becomes a challenging task. A precise impression of the resection defect is necessary for accurate obturation. This is not practical for patients who have restricted mouth opening, hence this crucial first step in the making of a good prosthesis is frequently accomplished by altering the conventional impression method. This clinical report details the prosthetic rehabilitation of a patient who was diagnosed with Adenoid cystic carcinoma of the left maxillary sinus. Patient underwent maxillectomy for tumor removal, which was worsened by trismus as a result of the procedure and radiation therapy. For orofacial rehabilitation and defect obturation, the patient was restored with a removable dental prosthesis with a hollow bulb obturator. An altered cast technique was used in the final impression making. This rehabilitation approach was successful in restoring lost function and appearance of the patient. Keywords: Maxillectomy, Hollow Obturator, Altered cast technique

3D-printed biomimetic scaffold with liposome-encapsulated SB431542 promotes scarless wound healing

Abnormal wound scarring often leads to functional impairments and cosmetic deformities, primarily driven by the prolonged activation of the TGF-β/Smad signaling pathway. Addressing this challenge, we developed a biomimetic scaffold aimed at facilitating rapid and scarless wound healing. This highly integrated 3D-printed dermal scaffold comprised modified recombinant human type III collagen (rhCOLIII-MA), gelatin methacrylate (GelMA), and liposomes encapsulating SB431542 to target TGF-β1 (Lip@SB). The rhCOLIII-MA/GelMA (CG) scaffold retained inherent biomaterial characteristics, exhibited tailored physicochemical properties, and demonstrated favorable biocompatibility. Moreover, the Lip@SB-loaded CG scaffold (CGL) effectively promoted in vitro wound healing, while enabling controlled release of SB431542 to inhibit pathological collagen deposition. In a full-thickness skin defect rat model, the CGL dermal scaffold combined with split-thickness skin graft (STSG) minimized scar contraction, stimulated functional neovascularization, and enhanced graft aesthetics comparable to normal skin. Remarkably, the performance of the CGL scaffold surpassed that of commercially available anti-scarring alternatives. This innovative strategy presents a straightforward approach toward scarless skin regeneration and holds promise in alleviating the prolonged, painful postoperative rehabilitation.

A Case Report of Arrhythmia Caused by Skin Expander Implantation

A 51-year-old female patient suffered facial burns during her youth. Following the healing of the wound, a skin expander was implanted on 7 December 2021 to address scar contracture. The preoperative electrocardiogram (ECG) indicated sinus rhythm within the normal range. Color Doppler ultrasound revealed no abnormalities. The patient had no history of hypertension, heart disease, diabetes, arrhythmia, or other cardiovascular and cerebrovascular conditions. On 16 June 2022, the skin expander was removed, and facial scar resection was performed. The routine ECG showed ventricular premature beats. During the operation, when the surgeon pulled and compressed the neck dilator, significant arrhythmia was observed, with the heart rate dropping below 50 beats per minute and frequent ventricular premature beats occurring. The surgeon promptly halted the procedure, resulting in immediate relief of the patient's pain. Subsequently, the ventricular premature beats ceased, and normal sinus rhythm was restored. Once the heart rate exceeded 60 beats per minute, the surgeon resumed the operation, but ventricular premature beats persisted. After removing the dilator, the heart rate gradually returned to normal, and no further arrhythmia occurred. The patient recovered smoothly post-operation, with stable vital signs and no reported discomfort. She safely returned to the ward. It was determined that the patient's arrhythmia was caused by the compression of the carotid sinus due to the stretching of the neck dilator.

Combining the Tunnel Orbicularis Oculi Muscle Flap Technique With Skin Grafting for Enhanced Adhesion in Burn-Induced Ectropion Repair.

Scar contracture of the eyelid following facial burns often has adverse consequences. Total cicatricial contracture often makes adjustment flap translation challenging to implement. Previously used upper and lower eyelid adhesion methods are ineffective for patients with severe cicatricial contracture, and ectropion can easily recur. This study aimed to retrospectively examine upper and lower eyelid adhesions using an orbicularis oculi muscle flap and verify its stability. In patients with ectropion caused by severe scar contracture following head and face burns, we employed a tunnel orbicularis oculi muscle flap technique, which involved creating a tunnel between the skin and the tarsal plate of the eyelid, mobilizing the orbicularis oculi muscle, and rotating it into this tunnel to provide stable adhesion of the upper and lower eyelids. Full-thickness skin grafting was then performed. The eyelids were examined postoperatively to determine whether reoperation was necessary and to monitor for any potential complications. This study included 26 patients and 46 eyes. No accidental disconnection occurred after eyelid adhesion, which lasted for an average of 21.87 ± 10.08 months before the eyelid adhesion was cut open. No complications or adverse reactions occurred, and the adhesions did not break unexpectedly. Repairing eyelid ectropion with the tunnel orbicularis oculi muscle flap is a simple procedure that immediately creates tension against upper and lower eyelid contractures, providing long-term stable adhesion. This method avoids structural disorders, such as eyelid margin scarring, minimally influences surrounding tissues, and has few postoperative complications. It holds great value for repairing eyelid tissue defects and warrants further study.

Multivariate Analysis of Risk Factors for Complications in Pediatric Tissue Expansion.

Tissue expanders represent one of the main surgical options for skin reconstruction in cases of tumors, traumalike burn injury, scar contracture, and alopecia. However, the tissue expander device is also associated with complications such as infection and extrusion. The aim of this study was to analyze risk factors for major complications of use of tissue expanders in pediatric patients using multivariate analysis. A retrospective, single-center observational study was performed over 10 years in pediatric patients who were treated with tissue expanders for tumors, nevus, scars, burn reconstruction, and alopecia from April 2012 to March 2022. The primary outcome was overall complications per operation and expander, including infection and extrusion. Ten predictor variables were included as risk factors based on previous studies and as new factors considered important from clinical experience. Univariate and multivariate logistic regression analyses were performed to identify risk factors for major complications such as expander infection or extrusion. The study included 44 patients who underwent 92 operations using 238 tissue expanders. The overall complication rate per expander was 14.3%. Univariate logistic regression analysis identified associations of younger age, number of expanders used per operation, history of infection, and tissue expander locations with a higher complication rate. In multivariate logistic regression analysis, younger age (odds ratio, 1.14; P = 0.043) was associated with a high likelihood of expander complications. Younger age is an independent risk factor for tissue expander complications in pediatric patients. This factor should be considered in preoperative planning and discussions with the patient's family.

Dorso Proximal Interphalangeal Island Flap

Background: This study aimed to demonstrate the clinical application of the dorsoproximal interphalangeal island flap as an alternative approach to skin graft or cross-finger flap to repair lesions at the ventral site at the proximal interphalangeal (PIP) finger joint. Methods: Fifteen patients received flaps (11 men and four women, n = 25 flaps). The repair of volar contracture in finger sequelae after burn injuries was the main indication. Five patients underwent two or more flaps during the same surgical session. The mean patient age was 18 years (range, 7–56 years). Most patients presented with palmar finger contractures of the PIP joint. In three patients, six flaps were rotated to the lateral radial and ulnar proximal surfaces of the finger to treat syndactyly. Results: Most flaps survived and provided satisfactory functional and aesthetic improvement of palmar scar contracture in the PIP region. Postoperative donor site follow-up was normal. The color and pliability of the skin are similar to those of the surrounding area. The follow-up period ranged from 6 months to 12 years. Conclusions: Dorsoproximal interphalangeal island flaps are an option for repairing lesions that lack soft tissue and range in size from 10 × 15 to 12 × 18 mm at the volar site and around the PIP joint. The arch of rotation of this flap allows for lateral, ulnar, and radial rotations around the joint. The indication of six flaps in three patients to repair a proximal lack of tissue caused by syndactyly demonstrated its potential use in this anomaly.

Abdominal closure with different oblique planes in island TRAM flaps: a method for achieving a better scar and contour of the donor site

Background An autologous abdominal flap can provide an aesthetically pleasing breast with a natural feel. However, contracted scars and hourglass contour deformities at the abdominal donor site can sometimes occur. These complications can reduce patient satisfaction and quality of life. Therefore, we performed different oblique plane closure of the abdominal donor site and evaluated the aesthetic scores in comparison with the conventional vertical single plane closure.Methods The procedures begin with a beveled incision down to the fascia level during transverse rectus abdominis muscle flap elevation. At the time of donor site closure, Scarpa’s fascia and the subcutaneous layers are sutured while being pulled downward. Sixty patients were divided into two groups: group A (single vertical plane closure) and group B (different oblique plane closure). Abdominal scars were scored by five reviewers using the scar scale.Results There were no significant differences in scores for vascularization, dog-ear presence, and umbilical shape of the scar between the two groups. However, group B showed marked improvements in flatness, contracture, and thickness of the scar surface. Notably, the different oblique plane closure in group B achieved much higher scores for the abdominal contour than group A.Conclusions The vertical single plane suture of the abdominal donor site may result in depressive contracture with poor cosmetic outcomes. The different oblique plane closure technique markedly improved the appearance of scars on the abdomen. This technique is likely to enhance patient satisfaction with both the breast and abdominal outcomes of breast reconstruction using an abdominal flap.

Pediatric Facial Burn Reconstruction.

Contrary to prior pediatric burn treatment philosophies, we now know that early burn excision and grafting for non life-threatening burns can compromise future reconstruction. Extensive scar excision should be minimized and scar rehabilitation maximized, as secondary iatrogenic deformities can become even more difficult to fix. Scar remodeling with local tissue rearrangement can relieve tension and soften scars over time. The majority of facial burns often only involve skin and can be adequately treated without the need for complex flap reconstruction. Facial burn scars are a different problem than facial burn scar contracture. The former needs scar rehabilitation, whereas the latter needs the addition of skin. Laser therapy has transformed the treatment of burn scars and is an incredibly valuable adjunct to local tissue rearrangement and grafting. The most favorable functional, aesthetic, and psychological outcomes require a long-term multidisciplinary effort and customized protocol utilizing the vast armamentarium of reconstructive tools described below.

Triangular Flap Insertion: An Option for Correction of Dog-Ears Deformity in High-Tension Areas.

Dog-ear deformity is a common protrusion defect of skin tissue after the closure of a surgical wound, affecting patients' appearance and quality of life. The common methods for correcting dog ears involve the removal of excess tissue in different directions or shapes after extending the incision along the long axis of the original wound. However, the literature regarding tissue preservation techniques for dog-ear correction is poor, especially for areas with insufficient skin tissue or high tension. The authors modified the original design of direct excisions, which transferred excess tissue from the horizontal axis of the wound to the longitudinal axis, thereby absorbing longitudinal tension and relieving linear scar contracture. This technique provides a way to correct dog ears without removing excess healthy tissue, especially as an option for dog-ear correction in high-tension areas.

Post-Operative Lower Eyelid Massage Versus Standard Care for Prevention of the Lower Eyelid Scar Contracture after Subciliary Approach in Traumatic Facial Fracture Repair: A Randomized Controlled Trial

Background: Subciliary incision, a common technique for traumatic facial repair, associates with lower eyelid scar contracture and malpositioning. Despite proposed management techniques like eyelid massage, the efficacy of post-operative massage remains unexplored in preventing and treating these issues. Objective: To assess the effectiveness of lower eyelid massage in preventing lower eyelid scar contracture and malposition following the subciliary approach for traumatic facial repair, compared to standard care without massage. Materials and Methods: A randomized controlled trial enrolled patients with traumatic facial fractures slated for subciliary approach repair. Patients were randomly allocated to the lower eyelid massage as the experimental group or standard care as the control group. The massage group received post-operative instructions. Data on demographics, injury profiles, lower eyelid scar contracture as graded by the grading of lower eyelid scar contracture (GLESCO) criteria, eyelid malpositioning, comfort scores, and complications were gathered over a 6-month follow-up. Results: The present study included 59 patients, with 30 in the massage group and 29 in the control group. There were no significant differences in demographic characteristics, injury profiles, or complications between the two groups. Post-operative assessments revealed the massage group exhibited a trend towards lower GLESCO grades with an average decrease of 0.72 grade per week (95% CI –1.46 to 0.02, p=0.058) and lower eyelid malpositioning grades with an average decrease of 0.49 grade per week (95% CI –1.03 to 0.05, p=0.073) compared to the control group. However, there was no significant difference in comfort scores between the two groups with an average difference of 0.18 score per week (95% CI –1.08 to 1.45, p=0.775). Conclusion: Lower eyelid massage demonstrated potential benefits in preventing lower eyelid scar contracture following traumatic facial repair. However, its impact on eyelid malpositioning and comfort scores was not statistically significant in the present study. Further study with larger sample sizes is warranted to validate these findings. Trial registration: ClinicalTrials.gov, NCT06311318 Keywords: Subciliary incision; Subciliary approach; Lower eyelid massage; Facial fracture; Scar contracture; Eyelid malposition; Ectropion

35 The Impact of Hand Burns on Strength; An Analysis of the ACT Database

Abstract Introduction Although hand burns comprise a small TBSA percentage, they can have significant functional implications. Multiple studies show grip strength as a predictor of health and quality of life. A decrease in grip strength has been reported in multiple populations with hospital admission; however, there is limited evidence concerning how burns affect hand strength. The purpose of this study was to examine the impact of burns on grip strength, measured at hospital discharge. Methods This study is a retrospective review of data from the prospective Burn Patient Acuity Demographics, Scar Contracture and Rehabilitation Treatment Related to Patient Outcome Study (ACT). Patients had grip strength measured of both hands 3 times consecutively at discharge. Data related to grip strength of patients with burn injuries were compared to age- and sex-matched normative values. Burn characteristics, including presence of hand burns, skin grafting, and length of stay were evaluated. Results There were 307 participants in ACT; 195 (63.5%) had hand burns and met inclusion for analyses. Among those with hand burns, the majority were male (72.8%), right-hand dominant (84.1%), mean ±SD age was 42.9±17.0; LOS, 23.3±22.8 days; and TBSA, 14.5%±13.3. Among patients with hand burns, 112 (57.4%) received skin grafts to at least one hand. Expressed as the percentage of grip strength loss relative to normative data, those with a burn injury to the hand averaged -55.8±33.4%, while those with no burns to the hand averaged -25.7%±36.3%, p < .001. Patients with a skin graft to the hand averaged -65.8±27.2% grip strength, while those with hand burns, but no grafts averaged -36.1%±35.5%, p < .001. Decreased grip strength is associated with increased length of stay, r= .21, p < .001. Conclusions This study of hand strength in burn survivors at the time of hospital discharge corroborates previous reports regarding nosocomial strength loss but specific to the hand. Overall, patients hospitalized with burn injuries lose hand grip strength but more-so if a hand is burned and furthermore if a hand is skin grafted. Applicability of Research to Practice Understanding of the impact of burns on grip strength may help guide clinical decision making, allowing therapists treating those with burn injuries to anticipate deficits and subsequent functional impact. Expectation of a loss of grip strength in patients without burns to the hands should inform treatment planning during acute hospitalization to promote improved function and quality of life.

789 Six Year Experience with Autologous Skin Cell Suspension for Burn Wounds

Abstract Introduction Autologous skin cell suspensions (ASCS) minimize the donor site required for addressing partial and full thickness burns. ASCS is currently FDA approved for use in combination with meshed split thickness skin grafts (STSGs) for full-thickness thermal burns in pediatric and adult patients. Besides the initial clinical trials of ASCS and STSG use for burn wounds, there are minimal studies reporting outcomes of their use. Here, we present our experience using ASCS in the past six years. We hypothesized that ASCS and STSG would result in a low reoperation and infection rate. Methods Retrospective review of patients seen at an American Burn Association verified burn center between 2017 and 2023 identified 15 patients treated with ASCS overlying STSG. Data collected included patient demographics, burn characteristics, surface area of ASCS usage, and patient outcomes. The primary outcome of interest was the requirement for reoperation following ASCS use. Secondary outcomes included hospital length of stay (LOS), ICU LOS, infection, and the necessity for scar revision via surgery or laser treatment. Data was analyzed using descriptive statistics with categorical variables presented as frequencies and percentages and continuous variables reported as medians and ranges. Results The median age of patients treated with ASCS was 36 years (13-67 years). The median BMI was 27.4 (17.7-35.4) and median total body surface area (TBSA) affected by burn was 18% (5.75-69.5%). Six patients (40%) had full thickness in addition to partial thickness burns. Most burns, 11 (73%) were the result of flames, although there were three grease burns and one friction burn. The median time to ASCS application was 10 days (1-39 days) and the median number of ASCS application sites was 2 (1-6). Most ASCS sites were on the upper or lower extremities or the torso; however, two patients had ASCS applied to their feet while another patient had it applied to their genitalia. Median ASCS surface area was 2,464 cm2 (289-20,000 cm2). Median LOS was 23 days (8-125 days) and median ICU LOS was 3 days (0-94 days). Four patients (26.7%) required reoperation on sites of ASCS application with the median time to reoperation being 40.5 days (28-66 days). Three patients (20%) required scar contracture surgery and three (20%) received laser treatments. There were no cutaneous infections in our cohort. Conclusions ASCS was effectively used to treat both partial thickness and full thickness burns and burns due to flame, grease, and friction. There did not seem to be any relationship between the necessity for reoperation after ASCS and the burn depth, etiology, surface area, or location. Applicability of Research to Practice Clinicians can look to our study for potential outcomes when using ASCS with STSG in a variety of situations.

797 The Development and Management of Neck Burn Scar Contracture Recurrence: A Single-Center Retrospective Cohort Study

797 The Development and Management of Neck Burn Scar Contracture Recurrence: A Single-Center Retrospective Cohort Study

Shwadamstradi Ghrita Uttarbasti the Ayurvedic Treatment of Urethral Stricture

In Ayurveda, Acharya Sushrut mentioned miraculous treatment for urethral stricture or mentioned as Mutrakruccha in Ayurvedic classical texts.Which briefly means difficulty in micturition. Mutrakruccha can be correlated withUrethral stricture due to the similarity between the symptoms. Many surgical and non-surgical treatments are available in modern medical science. Still, dueto thehigh recurrence and huge financial burden on the health system, Ayurvedic treatment Uttarbasti is showing promising results in the management of Urethral Stricture.Uttarbasti is the delivery of therapeutic oil or decoction via the urethra or vaginal channel.Urethral strictures can result from inflammatory, ischemic, or traumatic processes. These processes lead to scar tissue formation; scar tissue contracts and reduces the caliber of the urethral lumen, causing resistance to the flow of urine. Urethral strictures arise from various causes and can result in a range of manifestations, from an asymptomatic presentation to severe discomfort secondary to urinary retention. Retrograde urethrogram (RUG) is the main diagnostic tool to find urethral stricture and help find the length of the stricture. There is no modernmedical-science treatment for urethral stricture disease, however, urinary tract infections (UTIs) should be adequately treated before surgical intervention. Surgical treatment of urethral stricture disease is indicated when the patient has severe voiding symptoms, bladder calculi, increased postvoid residual, or urinary tract infection or when conservative management fails. Due to the high recurrence rate of surgical intervention in Urethral stricture non-invasive treatment such as Uttarbasti is always appreciated.

Global Surgery: Burn Outreach by Shriners Children's Texas.

Global surgery describes a rapidly developing field that seeks to improve surgical treatment internationally, specifically in those specialized treatments that are not readily accessible, considered complex and expensive. Burns cause 300,000 deaths annually, 90% of which occur in low- and middle-income countries (LMICs). Burns are a public health problem since they can cause disability and death. Shriners Children's Texas is a unique model of global surgery for an important number of countries in Central and South Americas and Mexico, providing specialized acute burn care with low mortality for burned children. Survivors of severe burns may face devastating sequelae due to burn scar contractures and hypertrophic burn scars that may limit the social reintegration. Burn reconstruction is not easily accessible to patients in LMICs. After discharge from acute burn treatment at our hospital, patients may return every 6 months for in-person follow-up to assess any surgical, psychological, or rehabilitative needs. Telemedicine allows for monitoring of postoperative results and evaluation for new surgical procedures. Follow-up clinic visits called outreach clinics held in international hospitals or international Shriners Temples allow for evaluation of follow-up patients and new patients with reconstructive needs that may benefit from a treatment in Shriners Children's Texas in Galveston, Texas.

Remedying The Consequences of Burn Injuries to The Upper Limbs

The effectiveness of a comprehensive treatment and rehabilitation approach for post-burn and mechanical injuries to the upper extremities has been confirmed through the analysis of both immediate and long-term outcomes. The strategy, involving scar correction surgeries, autodermotransplantation, and physiotherapy, has yielded successful and sustainable results. Patients facing scar contractures and trophic impairments have regained mobility and improved their quality of life, underscoring the efficacy of our treatment approach