Scarring After Burn Injury

Abstract

Burn injury is a trauma that has variable scarring outcomes dependent on both the size and the depth of the burn. This chapter will discuss the pathophysiology of wound healing by both primary and secondary intention and its applicability to burn wounds. The importance of accurate assessment of burn depth and its impact on the primary treatment and subsequent scar outcome will be explored. Special anatomic areas such as the face, hands and neck will be highlighted. Skin grafting and skin substitutes as treatment options will be reviewed. Improvements in burn care have enabled people to survive larger burns that may once have proved fatal. The emphasis of treatment, once healing has been achieved, is now focused upon rehabilitation and scar management. Scar management strategies including pressure garments and silicone therapy are highlighted along with secondary scar revision strategies.

Healing Mechanisms in Cutaneous Wounds: Tipping the Balance

“…Scarring from large burn wounds or burn wounds in functionally or cosmetically important areas (e.g., the hands, face, neck, and joints) may impart a significant burden on patients. 16 , 17 Scars can contribute to contracture in functionally or cosmetically important areas, reduced mobility, pain, itching, disfigurement, reduced quality of life, and psychological consequences (e.g., depression and anxiety). 16 , 18–21 Severe burns can also cause extensive nerve damage and peripheral neuropathy.…”

“… 16 , 17 Scars can contribute to contracture in functionally or cosmetically important areas, reduced mobility, pain, itching, disfigurement, reduced quality of life, and psychological consequences (e.g., depression and anxiety). 16 , 18–21 Severe burns can also cause extensive nerve damage and peripheral neuropathy. 22 In a systematic review, patients with burns reported the lowest scores in domains of work and heat sensitivity, bodily pain, physical role limitations, and pain/discomfort over the short term.…”