![]() Beyond aesthetics, these may include cicatricial microstomia (causing weight loss and malnutrition), loss of facial expression, and nasal deformity/tissue loss with associated airway dysfunction and loss of humidification. Warden, in Total Burn Care (Fifth Edition), 2018 Facial Injuries, Scars, and Ear/Nose/Throat Problemsīurn scars involving the face can be a significant cause of impairment. Ointments moisturize by blocking evaporation and reduce harmful scratching of healed skin grafts. Topical non-steroidal anti-inflammatory agents, anti-histamines, and other immunomodulators are useful to downregulate scar inflammation, which often persists long after the wound is epithelialized. Effect treatments requires induction of scar remodeling and softening. Initial therapy is focused on controlling scar pathogenesis. Hypertrophic scarring, unstable epithelium, and poor skin elasticity often occur when deep burns are allowed to heal without grafting. Hypertrophic scars occur in 60% of burned children aged under 5 years. Schierle reported an increase in testosterone receptors in hypertrophic scars, which may contribute to the formation of these scars during adolescence. Scar tissue cells are sensitive to the influences of the same growth factors that drive normal tissue growth and development. ![]() Hormonal influences are also known to be a factor, with hypertrophic scarring often initiated at the start of puberty or during pregnancy. These populations include people of African, Asian, and Hispanic descent. The natural history of hypertrophic scars is that they regress with time after injury, leaving behind, however, an unsightly wide gap of thinned dermis between wound edges.Ī familial pattern in hypertrophic scarring is not described however, populations with higher skin melanin content are known to have a higher incidence of hypertrophic scars. This anatomic dependency seems to correlate with patterns of skin tension. As a result of mechanical tension, scars located on certain areas of the body (e.g., sternum, deltoid, and upper back) are frequently hypertrophic, the typical appearance of which can be seen in Fig. Hypertrophic scarring also occurs as the result of dynamic mechanical skin tension acting on the healing wound. The incidence of hypertrophic scars following burn wound healing is close to 90%. They are especially pronounced in wounds that have a prolongation of the inflammatory and proliferative phases of wound healing. It is postulated that hypertrophic scars begin as the result of an injury to the deep dermis. Factors that increase inflammation include wound infection, prolonged healing by secondary intention, or immunologically foreign material present in the wound. Basically, prolonged wound inflammation, dynamic tension (shoulders, chest, volar forearm, and dorsal legs) on the wound, endocrine or hormonal factors associated with rapid growth, pregnancy, and pigmented skin predispose to hypertrophic scar formation. Several epigenetic causes of hypertrophic scarring are well known and important to consider. Hypertrophic scar formation after burn wound healing is a common obstacle to rehabilitation. Rather, the diagnosis is given to scars that are thicker than necessary. There is no quantitative definition of hypertrophic scarring. ![]() However, the wounds of burn patients often heal with excess (i.e., hypertrophic) scarring. Ideally, just enough scar forms for this purpose. The ideal scar is strong enough to subserve the mechanical requirements and support epidermal functions. Song MD, MBA, FACS, in Plastic Surgery: Volume 4: Lower Extremity, Trunk, and Burns, 2018 Managing burn scar hypertrophy and contracture 45–50
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