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Wound contracture following deep burn injury. Wound contracture is a process that may occur during wound healing when an excess of wound contraction, a normal healing process, leads to physical deformity characterized by skin constriction and functional limitations.
Burn scar contracture is the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area. This is mediated by myofibroblasts. [1]
[2] [4] Most infections are present within the first 30 days after surgery. [5] Surgical wounds can become infected by bacteria, regardless if the bacteria is already present on the patient's skin or if the bacteria is spread to the patient due to contact with infected individuals. [5]
In adjunct with surgery, refractory muscle contracture can also be treated with Botulinum toxins A and B; however, the effectiveness of the toxin is slowly lost over time, and most patients need a single treatment to correct muscle contracture over the first few weeks after surgery. [21] Shortening of the surgically lengthened muscle can re-occur.
Contraction can last for several weeks [46] and continues even after the wound is completely reepithelialized. [3] A large wound can become 40 to 80% smaller after contraction. [ 31 ] [ 42 ] Wounds can contract at a speed of up to 0.75 mm per day, depending on how loose the tissue in the wounded area is. [ 37 ]
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Surgery can help alleviate skin contractures in the form of skin grafts and removal of hypertrophic scars. [ 8 ] [ 6 ] For hypertrophic scars, timing is important when considering surgery, as over time scars will mature and may show decreased contractures along with flattening, softening, and repigmentation without surgical intervention.