Featuring Dr. Nancy Van Laeken, MD, FRCSC, Plastic Surgeon
Duration: 3 minutes

Once a patient has been burned, no matter how effective the skin healing has been, either by healing spontaneously or by skin grafting, the patients are often left with scars that they find esthetically unacceptable.

Not only do they not like how the scars look, if the scars are in areas such as the neck, across the elbow joint, or in the area of the fingers, the scars can reduce the patients activity because they become quite thick and they become shortened. Therefore, the patients are unable to move comfortably. They are unable to extend their arms.  They are unable to use their hands. 

Therefore, there are a number of different operations that have been designed to release the scar contractures and to allow the patients to feel more comfortable, to be more active, and to be able to function again more normally. There are different techniques, and there are different procedures and the timing of them is quite varied as well. 

Sometimes the scars are released and they are re-skin grafted and subsequent to the grafting, one of the important things is to maintain of the release is the appropriate occupational therapy and physiotherapy. So most of these treatments are not just about the surgery, it is about the after care that the patients receive and these are usually a sub specialized areas of care where the therapist will see and meet with the patients every week or two for up to a year.

Once the surgery to release the burn scares has been completed and the wounds have healed, the patients – there are different procedures that can be used. Some involve skin grafting with split thickness grafts or full thickness grafts and that is the type of skin that you apply to the defect. Sometimes it can be a flap. Sometimes muscles are transferred into the area where these reconstructive operations are quite complex. Therefore, this will allow for example, a patient with a neck contracture to be able to move their neck more comfortably and a contracture of their arm or elbow, the same is true.

Sometimes additional layers of pressure are applied under the [inaudible] which include sheets of silicon gel that again put pressure on the scar and allow them to be softer and again improve the color of the scar. What technique is used depends on the age of the patient, the location of the scar and the depth of the scar. 

In some circumstances, the patients will have a particular prosthesis placed which is called a tissue expander. It is put underneath their normal skin. It is stretched and in the process of doing that, the skin is stretched and that is then the harvested and used in another area of their body in that there is now some excess skin.

If patients have burned scars and wish to have an opinion as to whether or not they can be improved, then they should ask their family physician for a referral to a plastic surgeon who specializes in the area of burn scar reconstruction.