Burn Contractures

About Burn Contractures

Contractures form when deep burns heal with thick, inelastic scar tissue that crosses joints such as the neck, axilla, elbow, wrist, fingers, hip or knee. As scar matures and shrinks, it pulls structures into fixed positions, restricting movement and sometimes distorting features. Reconstructive burn surgery aims to release the tight scar, replace missing skin and protect the result with focused rehabilitation.

Initial assessment maps every restricted joint, the quality of surrounding skin and the impact on daily activities. We document range of movement, photograph posture and review previous treatments. Imaging is rarely needed except in deep contractures with suspected joint or bone involvement. The plan is then tailored to the patient's age, occupation and priorities, including which contractures matter most.

Burn contracture release surgery options include Z-plasty for narrow bands, multiple Y-V plasties for moderate scars, full-thickness skin grafts for larger flat areas and local or regional flaps for deep or critical sites such as the neck and axilla. Free flaps are reserved for very extensive contractures. Each technique has advantages, and we choose based on scar pattern, joint demand and aesthetic considerations.

Surgery is performed under general or regional anaesthesia. The contracted scar is released with careful planning to avoid neurovascular damage. The defect is then resurfaced with the chosen graft or flap. Post burn deformity treatment often combines several techniques in a single procedure, particularly across joints, where skin tightening after burns can otherwise recur quickly.

Postoperative care includes strict positioning to keep the released joint at full extension or abduction. Splints are worn during the day or night for several months, with physiotherapy starting after early healing. Pressure garments and silicone are used to control new scar formation. Hospital stay is usually two to five days, depending on the size and site of reconstruction.

Long-term outcomes depend on consistent splinting, exercises and scar care. Reviews continue for at least a year, with photographs documenting progress. Children require regular monitoring as growth can recreate contractures, and additional smaller procedures are sometimes planned. Our team supports patients and families with clear written instructions and structured follow-up throughout the recovery process.

What to expect

• Detailed assessment of joint movement and scar quality
• Tailored release using Z-plasty, grafts or flaps
• Combined procedures across multiple joints when appropriate
• Splints, pressure garments and silicone for scar control
• Coordinated physiotherapy starting after early healing
• Long-term reviews to monitor scar maturation and growth

Recovery

• Strict positioning of the released joint at full extension or abduction
• Hospital stay typically two to five days
• Daytime or night splinting for several months
• Pressure garments and silicone use during scar maturation
• Periodic reviews over at least a year, with photographs