Post Burn Contractures

What is a burn contracture scar?
A burn contracture is an area of skin that has undergone excessive scarring as a result of healing from a deep burn injury. Contractures can begin as a slight puckering of scar tissue but over time they can worsen, becoming thick bands of hypertrophic scars. These tight bands of scar tissue can restrict joint movement, lead to the loss of joint mobility, and permanently impair normal joint function.

What causes a burn contracture?
When deep skin wounds heal, new collagen is synthesized to strengthen the weakened tissue. Fibroblasts also contract to pull the wound edges together and shrink the wound’s surface area. Excessive scarring and joint contracture can occur when collagen deposition and fibroblast contracture continues once the wound has closed. Without splinting or pressure pulling in the opposite direction, such contractures can continue years after the original burn injury.

What burns are likely to contract?
The longer it takes a burn injury to heal, the more likely it is a burn contracture will form. More specifically, burns needing longer than 3 weeks to heal are more likely to produce unsightly hypertrophic scars and form contractures. As a result, patients who do not receive care shortly after they are burned are more likely to develop contractures. This is because this patient population is more susceptible to wound infection and less likely to have proper splinting. If there is little resistance to the shrinking affect of wound contraction, it is easy for a contracture to form. As a result, contractures usually appear when the scar line is vertical to the skin tension line, as in scars across a joint. Flexion contractures are more common than extension contractures.

Who is most likely to be burned?
In Pakistan burn injuries are very common in children, particularly infants and toddlers. Toddlers are frequently burn victims because they are too young to judge the danger of fire and are relatively uncoordinated. Burn victims typically come from poor families in rural regions, where fires are necessary for daily living and primary care is practically nonexistent.

Why are burn contractures so common?
Burn contractures are a major problem in Pakistan because families frequently have open fires in their homes for cooking and to provide heat. In rural districts, many homes have thin walls and lack windows so these fires are constantly lit in the winter. These fires are not shielded, and are often at ground level. As a result, children are exposed to open flames and hot cooking equipment, the common causes of deep burns, on a daily basis.