Burn Scars
Burn scars are thick (hypertropic) scars covering the area of the burn injury with a scar plate
Scar formation depends on the depth of the burn. I° burns and II° superficial burns (IIa) heal without noticeable scarring. The clinical rule of thumb for differentiating between superficial and deep 2-degree burns is therefore:
“A II° burn, that heals within 3 weeks can be classified as a superficial (IIa) burn injury”
Goals of treatment
1. Prevention of deeper burns through adequate initial treatment
2. Avoidance of excessive scar formation
a. Improvement of Scar souplesse
b. Improvement of scar shape and colour
3. Prevention and Removal of scar-related movement restrictions (contractures)
1) Prevention of deeper Burns through adequate initial treatment
In burn injuries, different zones of tissue damage can be distinguished:
⦁ Zone of coagulation: dead skin, cannot be changed
⦁ Zone of stasis: dynamic penumbra, which is the target of burn care. The extend of tissue damage and thus scarring can significantly reduced by:
⦁ good first aid
⦁ “adequate cooling” with cold water for 15 – 20 minutes, if possible)
⦁ adequate wound management (avoidance of any infection)
⦁ “keep closed blisters closed”
⦁ Zone of Hyperemia: Reactive inflammation, will return to normal within hours of injury regardless of care
2 ) Avoidance of Excessive Scar Formation
The most important factors influencing the avoidance of excessive scar formation are:
⦁ Early wound closure (see above)
⦁ adequate scar suppressive treatment
⦁ combined application of silicone sheet and customized compression (> 25 mmHg) garments is crucial in achieving maximum action of both treatment modalities, i.e.:
⦁ Hydration of the newly formed skin
⦁ Reduction of Scar Volume (Down-regulation of fibroblast production and reduction of collagen production)
⦁ Reduction of Redness = Scar Visibility (Acceleration of blood vessel occlusion)
3 ) Prevention and Removal of scar-related movement restrictions (contractures)
Scar contractures are functionally more important the closer they are to a joint and the more perpendicular they are to the Skin Lines. Basic principles of surgical scar correction are:
⦁ Interruption of the scar by inserted tissue
⦁ Change in the course of the scar (parallel to the skin tension lines)
