Surgical burn contracture release
In burn contracture release surgery, it is vital to plan the release incision and reconstruction of the defect.
Scars can contract to varying degrees, from a narrow single line to a large three-dimensional area. Different scars require different approaches. This is where knowledge and experience can make a huge difference.
In general, you can release a scar most effectively with an incision perpendicular (at a 90-degree angle) to the contracture formed by that scar.
In joint contractures, you should make the release incision perpendicular to the direction of the restricted movement of the affected joint, and in line with the axis of that joint. In practice, this means the release incision ‘points’ at the pivot of the joint.
When you plan the release incision, you must also plan the reconstruction technique for the defect.
However, this does not mean you have to make the release incision from one side to the other in the flexor crease of the joint, as this will interfere with the local flaps. Only use this approach when it is clear from the outset that local flaps are not feasible and that a skin graft will be used.
When you use local flaps, you need to design, plan and measure them carefully to achieve the best effect. This will help ensure you avoid designing local flaps that subsequently fail to form skin bridges across the defect, which results in a larger defect with frayed, undermined edges.