Modification of Post Burn Scar,

With the advances there have been in the care of burn injuries in the past decade, patients are now surviving much larger area burns than previously. This is not sufficeint - there must be good quality life, with good function and good appearance in both small and large burns. Patients expect this, and while constractures and hypertrophic scars cannot always be avoided despite adequate treatment, a good final result is generally possible and today reconstructive survey is rarely needed. The final cause of contractures and hypertrophic burn scars is not known despite much research but there are several hypotheses that are accepted almost as fact. Larson stated that the burn wound will shorten until it meets an opposing force. This has been borne out in clinical trials and is the basis of the use of splitage to help prevent burn contractures. At the same time he states that the position of comfort is the position of contracture, and, furthermore, as contractures commence within 48 hours of injury, we splint early we encourage active movements during the day and splint the affected limb at night in the optimal position to prevent contractures. Basically, to help prevent unsightly hypertrophic scars, we must anticipate which burns will develop hypertrophic scars and work to minimize this scarring.