Post-burn contractures are tight scars that form as deep burns heal by contraction, pulling the skin and restricting movement of joints, the neck, eyelids or mouth. Treatment combines scar care such as pressure garments, silicone and splints with surgical release using Z-plasty, skin grafts or flaps, usually once the scar has matured.
- AnaesthesiaGeneral or regional
- DurationUsually a few hours
- Hospital stayUsually a few days
- Back to routineTypically 3 to 6 weeks, with therapy continuing for months
What is post-burn contractures and scarring?
Deep burns often cannot heal on their own in time without skin grafting. Instead, they heal by contraction, pulling surrounding skin inward. This causes contractures and raised scars that restrict movement. Scarring depends on burn depth and is largely unavoidable; only superficial dermal burns heal without it. Therapy and plastic surgery reduce scarring but cannot remove it completely.
The risk of contracture can be reduced by correct positioning, early cover of the burn with skin grafts or flaps, day and night splints, preventing infection, and daily stretching. Healed skin and donor sites tend to be dry, so emollients help keep skin supple and reduce itching, though overuse can cause boils (furuncles). Antihistamines may be prescribed for itching. Compression garments help prevent hypertrophic scars once the skin is stable, silicone gel sheets worn around the clock also help, and sun avoidance prevents darkening. Long-standing unstable scars can rarely become malignant.
Surgery is generally delayed until the scar matures, usually about a year, because operating on an immature, highly vascular scar causes more bleeding, poorer graft take and further contraction. Earlier surgery is considered for eyelid ectropion threatening the eye, neck contractures that prevent looking forward, severe microstomia affecting nutrition and oral hygiene, crippling hand contractures, contractures of both knees preventing upright posture, contractures with chronic raw areas or infected scars, and severe disabling contractures unlikely to improve with physiotherapy.
Who is post-burn contractures and scarring for?
- People with contractures after second- or third-degree burns
- Patients whose scars limit movement of the neck, shoulder, hands, knees or feet
- People with burn scars pulling on the eyelids or mouth
- Patients with unstable or repeatedly breaking-down burn scars
- People with raised, itchy hypertrophic burn scars
How is it done?
- Usually takes a few hours; the limb is padded and a tourniquet applied where appropriate
- Z-plasty for mild, band-like contractures
- Incisional or excisional release for wider contractures
- Cover of the released area with split-thickness grafts (usually from the upper thigh) or full-thickness grafts (usually from the abdomen)
- Flaps when joints, tendons, bone, vessels or nerves would be exposed, when further nerve or tendon surgery is planned, or for a better cosmetic result
What is recovery like?
- The corrected position is usually held for about 3 weeks until the graft stabilises or flap edges heal
- A splint or pressure dressing is worn in the first weeks
- Physiotherapy starts once grafts or flaps have settled
- Scar massage, stretching and static or dynamic splints help prevent recontracture
- Care typically continues for more than a year after release
What are the risks?
- Recurrence of the contracture (recontracture)
- Partial graft or flap loss
- Infection or bleeding
- Hypertrophic scarring at the new margins
- Need for further staged releases
Why choose Dr. Jithendran?
- Dual training in orthopaedics (MS) and plastic surgery (MCh, DNB), with hand and microsurgery experience from Ganga Hospital, Coimbatore
- Consults at five hospitals across Bengaluru, with 24×7 availability for emergencies
- Clear explanations in English, Tamil, Hindi and Telugu, and time to answer every question
- Strict sterilisation and patient-privacy standards
Frequently asked questions
How long should I wait before having burn contracture surgery?
Usually until the scar matures, which typically takes about a year. Mature scars bleed less and grafts take better. Earlier surgery is considered when the contracture threatens the eye, prevents eating or neck movement, cripples the hand, or cannot be helped by physiotherapy.
Can burn contractures be prevented?
The risk can be reduced by early skin graft cover of deep burns, correct positioning, splints worn day and night, preventing infection and daily stretching. After healing, pressure garments, silicone gel sheets, moisturisers and sun protection help limit raised scars.
What is a Z-plasty?
A Z-plasty is a technique in which Z-shaped incisions are made across a tight scar band and two small triangular flaps are swapped. This lengthens the scar line and changes its direction, releasing tightness. It is suited to mild, narrow contractures.
Will the contracture come back after surgery?
There is a risk of recurrence, which is why aftercare matters. Holding the corrected position for about three weeks, wearing splints and pressure garments, scar massage and continued stretching, often for more than a year, help maintain the range of movement achieved.
Can burn scars be removed completely?
No. Therapy and plastic surgery can make scars softer, flatter, less tight and less noticeable, and restore movement, but they cannot fully erase scars. A realistic plan focuses on function first and then on improving appearance.
