Salamanders Young Burn Survivors > Facts and Figures > Scars and Treatment

Types of Scars

Flat, Pale Scars are the most common type of scars resulting from the body's natural healing process. They may be dark and raised at first, but become paler and flatter over a period of about two years.

Contractures happen when the loss of a large area of skin forms a scar that pulls the edges of the skin together, a process called contraction. The resulting contracture may restrict normal movement.
A contracture is usually corrected by cutting out the scar and replacing it with a skin graft or a flap, which may involve tissue expansion. Sometimes Z-plasty may be used.

Hypertrophic Scars may result from excess production of collagen fibres. They usually develop within the first 4 to 8 weeks following the injury. They appear as pink, firm, raised bands within the boundaries of the original injury. They may continue to thicken for up to 6 months. They may be itchy or painful, and may also restrict movement. They usually improve over the next year or two. They are more common in the young and in people with darker skin, and some people have an inherited tendency to this type of scarring.
Hypertrophic scars can often be improved surgically. The plastic surgeon will remove excess scar tissue, and may reposition the incision so that it heals in a less visible pattern. You may receive steroid injections during surgery and at intervals for up to two years afterwards to prevent the thick scar from forming again. Laser treatment can also improve hypertrophic scars.

Keloid Scars happen when the body goes on producing collagen after a wound has healed. Keloids are thick, puckered clusters of scar tissue that grow beyond the edges of the injury. They are often red or darker in colour than the skin around them. They may also be itchy or painful. They may carry on growing indefinitely and may not improve in appearance over time. The young and people with darker skin are more likely to have this type of scarring, which is a genetically inherited trait.
Keloids are often treated by injecting a steroid medication directly into the scar tissue to reduce redness, itching, and burning. In some cases, this will also shrink the scar. Excess scar tissue can be surgically removed, and the wound closed with stitches. A skin graft is sometimes used, although the site from which the graft was taken may then develop a keloid. Keloids have a stubborn tendency to grow back again, sometimes even larger than before. To discourage this, you may be asked to wear a pressure garment over the area for as long as a year, or the surgeon may combine the scar removal with steroid treatment or radiation therapy. Even so, the keloid may come back, requiring repeated procedures every few years. Laser treatments, cryosurgery, injections of a long-acting cortisone, and interferon injections have all also been used to treat keloids.

Stretched Scars occur when the skin around a healing wound is put under tension during the healing process. The scar may appear normal at first, but can widen over a period of weeks or months.

Sunken Scars are pitted or recessed into the skin. The underlying skin may be attached to deeper structures (such as muscles) or there may be loss of fat at the site of the wound.

Scar management

Scar management is the attempt to control how scars form during healing; trying to prevent deformity, optimise function and improve appearance.

Exercise Therapy helps to maintain and improve strength and flexibility, reduces swelling in arms and legs, decreases the likelihood of blood clots, and increases bone density.

Pressure or Compression Therapy involves the careful application of tight-fitting garments and bandages to an area where a burn injury has occurred. These are worn day and night until the wounds mature (12-18 months post-burn) to prevent excessive scarring from taking place.
Pressure bandages may be used to help reduce oedema (swelling) and in early scar management.
Pressure garments, usually custom-made from an elastic material, are most often used for burn scars that cover a large area. They are most effective when applied as soon as the burns have healed, but can help even if first used up to two years after the injury.
Inserts are designed to tightly conform to different parts of the body in order to provide more even pressure. They can be made from a variety of materials, from soft foams to hard plastics, and are worn under a person's pressure garments.
Splints and Casts are custom-made or fitted to provide support and protection, and to maintain or increase the range of movement in joints by preventing contractures.
UVEX face masks are custom-made of semi-rigid plastic which applies pressure to the scarred soft tissue areas of the face.

Radiation Therapy, sometimes used to reduce the recurrence rate of hypertrophic and keloid scars after surgery, is effective in about 70% of cases, but is reserved for the most serious cases because of the possibility of long-term side effects from radiation.

Scar Massage helps to soften scars and can help prevent contractures. It can also help to relieve the itching and pain that affect many burn survivors. Scar massage is generally done two or more times a day and is sometimes combined with heat and lotion. Only gentle massage should be done to newly-healed skin, because the skin is fragile and may blister or break down. As the skin becomes stronger, greater pressure can be used.

Silicone Gel Sheets are helpful in flattening, softening and fading red and raised scars. They are applied to healed wounds on clean skin and can be worn constantly, held in place by tubigrip, pressure garments, splints or adhesive tape.

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