Comprehensive Overview of Post-Burn Deformities: Causes, Prevention, and Treatment

Comprehensive Overview of Post-Burn Deformities: Causes, Prevention, and Treatment

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  POST-BURN DEFORMITIES PROF. MRSREGI PHILIP MT.ZION COLLEGE OF NURSING,ADOOR
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  INTRODUCTION • Severe ordeep burns lead to acquired post-burn deformities—most notably joint contractures, hypertrophic scars, and web-space adherence— caused by skin shrinkage and healing abnormalities. Burn injuries can leave behind severe deformities that not only affect physical appearance but also significantly impair mobility and daily functioning. • These deformities often result from contractures, hypertrophic scars, or skin graft complications and can involve any part of the body, including the face, hands, neck, torso and limbs.
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  BURN DEFORMITIES • Burndeformities typically result from severe thermal injuries, electrical burns, chemical burns, or delayed wound healing. These deformities can manifest as: • Contractures: Thick, tightened skin that restricts movement, especially in joints or along flexor surfaces. • Hypertrophic Scars and Keloids: Thick, raised and often itchy scars that form at the injury site. • Scar Bands: Restrictive scar tissue that limits motion and flexibility. • Skin Graft Deformities: Irregular or uneven scars after skin graft procedures. • Pigmentary Changes: Discoloration or patchy pigmentation in affected areas.
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  COMMON POST-BURN DEFORMITIES •Contractures: Tight, thickened bands of scar tissue that cross joints, restricting movement (e.g., locking the elbow, knee, or neck in a bent position). • Claw Hand Deformity: Hyperextension of the knuckles and flexion of the finger joints due to tight dorsal scarring and swelling. • Microstomia: Severe tightening and shrinking of the tissue around the mouth, making eating and oral hygiene difficult.
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  COMMON POST-BURN DEFORMITIES •Ectropion: Eyelid scarring that pulls the lid outward, exposing and endangering the eye. • Syndactyly: Fingers or toes sticking and healing together due to circumferential skin loss.
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  CONTRACTURES • A burncontracture is a permanent tightening of skin, muscle, or tendons that happens after a severe burn. It occurs when deep scar tissue forms and shrinks during healing, pulling tight across joints like the neck, elbow, or fingers and stopping normal movement
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  CONTRACTURES • Causes andRisks • Deep second-degree or third-degree skin damage. • Scars taking a long time to heal. • Staying too long in a "position of comfort" (like curled up) rather than a straight position. • Skipping physical therapy or splinting
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  PREVENTION AND NON-SURGICALCARE • Prevention and Non-Surgical Care • Stretching: Do daily range-of-motion exercises to keep tissue flexible. • Splints: Wear custom splints to hold joints in a straight, anti-deformity position. • Pressure: Use pressure garments early on to flatten raised scars. • Massage: Massage the healing skin to break up tight fibers
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  SURGICAL TREATMENT • ReleaseSurgery: A doctor cuts or removes the tight scar tissue to open the joint. • Skin Grafts: Healthy skin is moved from another part of the body to cover the open space left by the release. • Flaps: Local tissue or muscle is shifted to restore a healthy layer of skin and blood flow
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  CLAW HAND DEFORMITY •Claw Hand Deformity: Hyperextension of the knuckles and flexion of the finger joints due to tight dorsal scarring and swelling.
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  CLAW HAND DEFORMITY •Claw hand deformity is a condition where the fingers curl into a claw-like shape due to nerve damage and muscle imbalance in the hand. It features bent middle and finger tips (interphalangeal flexion) alongside pulled-back base joints (metacarpophalangeal hyperextension), commonly tied to ulnar nerve injury • Signs and Symptoms • Fingers stuck or bent in a claw posture (frequently the ring and little fingers) • Trouble straightening or extending the fingers • Numbness, tingling, or loss of feeling in the hand and specific fingers • Weak grip and loss of fine motor coordination • Wasting or thinning of the small muscles in the palm and between bones
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  CAUSES AND TREATMENT •Treatment Options • Wearing dynamic splints or anti-claw braces to realign joints • Physical and occupational hand therapy for stretching and strengthening • Medications for pain or inflammation management • Surgical interventions including nerve repair, tendon release, or tendon transfers
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  MICROSTOMIA • Microstomia isa medical condition defined by an abnormally small mouth opening. It can be congenital (present at birth, often linked to genetic syndromes like Freeman-Sheldon syndrome) or acquired later in life due to severe facial burns, trauma, cancer surgery, or systemic hardening of the skin from scleroderma • Microstomia: Severe tightening and shrinking of the tissue around the mouth, making eating and oral hygiene difficult.
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  CAUSES AND TYPES •Congenital factors: Inherited craniofacial syndromes and genetic abnormalities. • Acquired scarring: Severe thermal, electrical, or chemical facial burns. • Systemic disease: Autoimmune conditions like systemic sclerosis (scleroderma) causing perioral tissue tightening. • Medical interventions: Head and neck radiation, or surgical removal of orofacial tumors
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  TREATMENT AND MANAGEMENT •Common Symptoms • Eating challenges: Trouble biting into food, chewing, or swallowing. • Speech limitations: Difficulty articulating certain sounds or words clearly. • Oral hygiene barriers: Inability to brush and floss properly, leading to high dental decay risk. • Clinical constraints: Severe obstacles for routine dental care, endodontic treatment, or fitting dentures. • Treatment and Management • Physical therapy: Active facial stretching and passive jaw exercises using specialized intraoral stretching appliances. • Orthotic devices: Use of dynamic or static mouth splints to preserve or gradually increase the oral opening. • Surgical correction: Commissurotomy or reconstructive flap procedures • (such as local Z-plasty or skin grafts) to release tight scar bands and widen the aperture.
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  ECTROPION • Ectropion: Eyelidscarring that pulls the lid outward, exposing and endangering the eye. • Ectropion occurs when facial burn scars shrink and pull the eyelid outward. This exposes the eyeball, prevents complete eye closure, and causes severe dryness, corneal ulcers, and potential vision loss. Treatment requires urgent eye lubrication and surgical scar release with skin grafts.
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  ECTROPION • Signs andSymptoms • Inability to fully close the eyelids (lagophthalmos) • Outward sagging or turning of the lower or upper eyelid • Chronic eye dryness, redness, and a burning sensation • Excessive tearing or watering (epiphora) • Blurred vision, light sensitivity, or corneal damage (exposure keratopathy
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  MANAGEMENT AND TREATMENT •Eye Protection: Use frequent artificial tears, lubricating ointments, and moisture chambers to protect the cornea from drying out.Temporary Measures: • Temporary procedures like tarsorrhaphy (partially sewing the eyelids together) may be used to shield the eye before final reconstruction. • Surgical Correction: The definitive treatment involves releasing the tight scar tissue, repositioning the eyelid, and placing a full-thickness skin graft (FTSG) or local tissue flap to restore missing eyelid skin length
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  SYNDACTYLY • Fingers ortoes sticking and healing together due to circumferential skin loss. • Post-burn syndactyly is the abnormal fusing or webbing of adjacent fingers. It happens when deep hand burns heal without proper skin grafts or splinting, causing raw skin surfaces to stick together with tight scar tissue. • This limits hand movement and grip.
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  POST-BURN SYNDACTYLY • Causes •Deep tissue damage: Full-thickness or deep partial-thickness burns destroy the delicate skin between the fingers. • Improper healing: Fingers kept in a flat or adducted position during recovery fuse as scars tighten. • Delayed grafting: Failing to cover raw areas with skin grafts promptly lets adjacent granulating surfaces stick and heal together.
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  TREATMENT AND MANAGEMENT •Prevention: Early splinting in an intrinsic-plus position (slight wrist extension, flexed knuckles, straight finger joints), proper positioning, and early physical therapy stop web spaces from closing • Treatment and Management • Surgical release: Doctors carefully cut and separate the fused scar tissue while protecting underlying nerves, blood vessels, and tendons. • Flap and graft reconstruction: Surgeons use local tissue rearrangements—such as Z-plasties or specialized flip- flaps—alongside full-thickness skin grafts to line the new web spaces and prevent re-fusion. • Rehabilitation: Intensive physical and occupational therapy paired with custom splints ensures the fingers maintain their full range of motion during recovery.
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  SURGICAL TREATMENTS • ScarRelease (Contracture Release): Cuts open or removes tight scar tissue over joints.Z-Plasty: Rearranges small skin flaps in a "Z" pattern to break up tight lines and ease tension. • Skin Grafts: Uses thin or thick layers of healthy skin from another body site to cover raw areas. • Flap Surgery: Moves muscle, fat, and blood vessels along with skin to cover exposed tendons or bone. • Gradual Distraction: Employs specialized external devices like the Ilizarov method for severe, long-standing joint contractures
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  ILIZAROV METHOD • anorthopedic surgery technique used to lengthen or reshape bones through distraction osteogenesis, relying on a circular external metal frame and gradual mechanical stretching. Developed in the 1950s by Soviet physician Gavriil Ilizarov, it prompts the body to naturally grow new bone, blood vessels, and soft tissue.
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  ILIZAROV APPARATUS • TheIlizarov apparatus is a type of external fixation apparatus used in orthopedic surgery to lengthen or to reshape the damaged bones of an arm or a leg; used as a limb- sparing technique for treating complex fractures and open bone fractures; and used to treat an infected non-union of bones, which cannot be surgically resolved. The Ilizarov apparatus corrects angular deformity in a leg, corrects differences in the lengths of the legs of the patient, and resolves osteopathic non- unions; further developments of the Ilizarov apparatus progressed to the development of the Taylor Spatial Frame
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  ILIZAROV APPARATUS • TheIlizarov apparatus is a specialized external fixator of modular construction, composed of rings (stainless steel, titanium) that are transfixed to healthy bone with Kirschner wires and pins of heavy-gauge stainless steel, and immobilized in place with additional rings and threaded rods that are attached with and through adjustable nuts. The circular construction of the apparatus, the rods, and the controlled tautness of the Kirschner wires immobilizes the damaged limb to allow healing
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  BONE DEFORMATION REPAIR •The Ilizarov apparatus corrects deformed bones by way of the process of distraction osteogenesis, which reproduces bone tissues. After an initial surgery during which the bone to repair is fractured, and the apparatus is attached to the limb of the patient; once the fracture has been immobilised, the bone tissues begin to grow and eventually bridge the fracture with new bone. In the course of the osteogenesis process, the bone grows and the physician extends the rods of the Ilizarov apparatus to increase the space between the rings at each end of the apparatus. • As the rings are installed at and connected to the opposite ends of the fracture site, the adjustment, done four times a day, separates the healing fracture by approximately one millimeter per day; in due course, the millimetric adjustments lengthen the bone of the damaged limb. • Upon completing the bone-lengthening phase of treatment, the Ilizarov apparatus remains emplace for a period of osteopathic consolidation, the ossification of the regenerated bone tissues. Using crutches, the patient is able to bear weight on the damaged limb; once healed, the patient undergoes a second surgery to remove the Ilizarov apparatus from the repaired limb. The result of the Ilizarov surgical treatment is a limb that is much longer than before the medical treatment.
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  THE PROCEDURE • Surgery(Corticotomy): The surgeon cuts the targeted bone (such as the tibia or femur) while carefully protecting the surrounding blood supply and soft tissues. • Frame Application: An external circular metal ring fixator is attached to the limb using thin trans-osseous wires and tensioned half-pins drilled straight through the bone. • Distraction Phase: After a brief resting period, the patient or caregiver turns the threaded nuts on the device a fraction of a millimeter daily (typically about 1 mm per day divided into four increments) to slowly pull the bone ends apart. • Consolidation Phase: Once the desired length or alignment is achieved, the frame stays locked in place for several months without adjustments while the newly formed soft bone hardens and matures into solid bone
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  NECK AND FACETIGHTNESS • Neck and face tightness: Pulling the chin down to the chest or turning down the eyelids and lips. • Neck and face tightness in post-burn deformities stems from scar contractures—thick, rigid bands of fibrous tissue that form as deep dermal or full-thickness burns heal. This tightening pulls on surrounding skin and structures, frequently restricting head and jaw movement, turning down the lower lip, or pulling down the eyelids.
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  CAUSES AND EFFECTS •Scar Contractures: Immature or unyielding collagen cross-linking restricts skin pliability. • Extrinsic Pull: Neck tightness exerts downward and outward tension on the lower face, distorting the mouth and chin. • Functional Limits: Difficulty tilting the head back or turning side to side. • Facial Distortion: Ectropion (pulling down of eyelids), lower lip eversion (drooling/exposure), and microstomia (tightening of the mouth opening).
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  MANAGEMENT AND TREATMENTAPPROACHES • Surgical Release: Cutting or excising tight scar bands, prioritized by addressing the neck first to relieve upward/downward facial tension. • Reconstructive Coverage: Utilizing split or full-thickness skin grafts, local flaps, tissue expanders, or microvascular free flaps to restore tissue laxity. • Physical Therapy: Consistent stretching, positioning splints, and pressure therapy garments to maintain gains achieved through surgery or prevent worsening tightness. • Multidisciplinary Care: Coordinated input from plastic surgeons, maxillofacial specialists, and physical therapists.
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  HYPERTROPHIC SCARS ANDKELOIDS • Hypertrophic scars and keloids: Thick, red, raised scars that grow past the original burn line • Hypertrophic scars and keloids are thick, raised fibrous growths caused by abnormal healing after deep dermal burn injuries. • Hypertrophic scars stay within the burn boundaries and often improve slowly, whereas keloids grow past the original wound edges and rarely fade on their own. Both cause itching, pain, and tight joint movement.
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  HYPERTROPHIC SCARS& KELOIDS •Hypertrophic Scars: • Raised, red, stay inside the injury line, and often shrink over time. • Keloids: Thick, aggressive, grow past the injury line, and do not fade without treatment. • Burn Connection: Deep partial-thickness or full-thickness burns that take weeks to close are high-risk
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  PREVENTION AND MANAGEMENT •Pressure Therapy: Custom compression garments worn daily to flatten the tissue. • Silicone Products: Gel sheets or topical silicone applied to soften and hydrate raised skin. • Injections: Steroid shots (corticosteroids) injected into the scar to lower inflammation and shrink tissue. • Advanced Care: Laser treatment, cryotherapy, or surgical revision if movement is blocked.
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  TREATING A KELOIDBURN SCAR Treating a keloid burn scar involves methods to flatten, soften, and shrink the raised tissue, as keloids extend beyond the original burn wound. Common approaches include steroid injections, silicone gel sheets, cryotherapy, laser therapy, and combination surgeries. Because keloids can return and sometimes grow larger after removal, treatments are often paired together
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  PREVENTION AND CARE •Early Closure: Quick surgical removal of dead tissue and skin grafting. • Pressure Garments: Custom elastic pressure wear used daily after the skin heals. • Silicone Sheets: Soft gel pads placed over the skin to flatten raised tissue. • Medical Treatments • Steroid Shots: Medicine injected into the scar to lower swelling.Laser Therapy: Light treatments to fade redness, flatten tissue, and stop itching. • Surgery: Cutting out the scar, often paired with other treatments to stop it from returning
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  Z-PLASTY: • Z-plasty: Changingthe direction of skin tension to relax tight scars in small areas. • Z-plasty is a plastic surgery method used to fix tight burn scars. A doctor makes a Z-shaped cut over the tight scar and swaps the skin triangles. This makes the tight scar longer, eases pulling, and moves the scar into natural skin folds
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  HOW Z-PLASTY WORKS •How Z-Plasty Works • Lengthens tissue: Standard 60-degree cuts can stretch a tight scar by up to 75 percent. • Relieves pull: It stops the tight scar from pulling on joints and moving parts. • Hides scars: It rotates the scar line so it sits better inside natural skin folds
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  COMMON USES OFZ -PLASTY IN BURN CARE • Joint movement: Frees tight scars across the neck, armpits, elbows, and hands. • Improving function: Helps patients move and stretch stiff areas again. • Better look: Breaks up harsh straight lines to make scars less obvious
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  CONCLUSION • Deformities dueto burns happen when deep scars tighten and pull the skin, muscles, and joints out of place.This is called a contracture. It limits movement, changes body shape, and causes tight, raised scars.
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  PREVENTION AND MANAGEMENTOF POST BURN DEFORMITIES • Early Intervention: Prompt wound care, early skin grafting, proper positioning, and custom splinting during the acute phase minimize scar tightening. • Therapy: Aggressive physical and occupational therapy keeps joints flexible and stretches healing skin. • Surgical Release: Reconstructive surgery—including scar release, skin grafts, or flap covers—is often required to restore movement and function.