Cryosurgery. Cryosurgery can help reduce the size of scars by freezing the upper layers of the skin. Freezing causes blisters to form on the skin. Some scars caused by skin conditions such as acne and chickenpox may have a sunken or pricked appearance. Niessen FB, et al. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg 1999;104:1435-1458 Immediate or gradual release: In general, the contracture should be completely dissolved on the table immediately. However, with severe long-term contractures, there is a significant shortening of musculo-tendon units and neurovascular structures. Therefore, it may not be possible to obtain a full release.
Even if the joints are subluxed or dislocated [Figure 12], immediate complete release may not be possible. In all these cases, as much release as possible is performed, and then the complete correction is carried out gradually over a few weeks with the series splint, skin / skeletal traction or modern distraction systems (e.B. UMEX, IESS, etc.). Once the complete correction is obtained, the skin cover is provided. Specific dermatological procedures to minimize scarring are determined by your doctor based on the following factors: Unlike keloid scars, hypertrophic scars do not extend beyond the boundary of the original wound. They can thicken for up to 6 months before gradually improving over a few years. In addition, deeper tissues may be due to their involvement in the initial burn (e.B. electrical burns) or as a result of the presence of skin contracture over a longer period of time of many years, which leads to a shortening of muscle units and neurovascular structures. The joints may be subluxed [Figure 10] or dislocated, with the joint capsule and ligaments becoming narrow in the direction of contracture.
Bones can be deformed, especially in adolescents, by .B mandibular deformity in post-burn contractures of the neck [Figure 11]. The presence of one or more of the above elements as well as a contracture may modify the physical therapy and / or surgical treatment of a contracture. For example, an unstable scar or chronic non-healing ulcers do not heal surgically from the contracture. Physiotherapy before surgery may not be possible in these cases. Massive raw areas require wound closure with skin graft before the contracture can undergo physical therapy. Wide excision of Marjolin ulcer should be combined with the release of contracting ligaments. A post-burn contracture associated with a hypertrophic or atrophic scar or a depigmented area may require excision to achieve the best results not only functionally, but also aesthetically. Scar contracture, on the other hand, is the end result of the contraction process. Pfau EE, Madden JW, Trier WC.
Biological basis for the treatment of keloids and hypertrophic scars. South Med J 1970;63:755-760 Laser resurfacing. Laser resurfacing uses high-energy light to burn damaged skin. Laser resurfacing can be used to minimize wrinkles and refine hypertrophic scars. Surgical revision of scars. In the surgical revision of the scar, the entire scar is surgically removed and reconnected to the skin. A new scar will form. But the purpose of this surgery is to create a less obvious scar. Surgical revision of scars is usually done on large or long scars, scars that have healed in unusual ways, or scars in highly visible places. Z-plastic. This procedure uses a Z-shaped incision to reduce the amount of contractures in the surrounding skin.
He may also try to move the scar so that its edges look more like normal fine lines and wrinkles of the skin. Small stitches can be used to hold the skin in place. Perkins K, Davey RB, Walis KA, silicone gel: a new treatment for burns and contractures. Burns 1982;9:406-410 Several treatments can make scars smaller or less visible. Your doctor may recommend a treatment or combination. The treatment of scars depends on several factors, including: Apfelberg DB, et al. Preliminary results of argon and carbon dioxide laser treatment of keloid scars. Lasers Surg Med 1984;4:283-290 Hypopigmentation and hyperpigmentation after healing burns, whether spontaneous or with skin grafts, are very common, although little is known about their cause. Depigmented patches or vitiligo are not only unsightly for the patient and the viewer, but also a taboo in our society, especially in areas such as the face, hands and feet that are not covered by the usual clothes.
The treatment includes excision/dermabrasion of the vitiligo area and covering with a thin skin graft of split thickness.  The color may not exactly match the environment, but overall it mixes with the surrounding scars and grafts, giving a satisfactory result. Very small areas can be tattooed with appropriate colors. It is also recommended that patients with hypopigmentation and hyperpigmentation use cosmetics. A number of patients who do not receive appropriate special treatment heal over a longer period of time by healing. This scar or neoepithhelium is usually unicellular and very fragile and must break due to mild trauma, especially if it is present on the extremities and other areas of stress (unstable scars). .