Burn Sequelae

They are changes that remain after the burn has healed and the acute phase has ended. They may include raised, adherent, widened, depressed or pigmented scars, altered skin texture, and scar bands or contractures that cause pain, stiffness or restricted movement.

Adherent, hypertrophic, widened, pigmented or depressed scars can be assessed, as can scar bands or contractures that restrict movement. Suitability for treatment depends on the scar, the area involved, symptoms and functional impact.

It is an area of scar tissue that shortens and pulls on the skin. When it crosses a joint or another mobile area, it can reduce range of movement, alter posture or make everyday activities more difficult.

Selection takes account of the scar type, location, extent and maturity, functional restriction, the quality of nearby skin, previous treatment and the patient’s goals. Different areas in the same patient may require different techniques.

No. Depending on the scar, management may include moisturising, massage, stretching, physiotherapy, silicone, pressure therapy, splints, injections or laser treatment. Surgery is considered when there is a significant deformity, functional restriction or an inadequate response to non-surgical measures.

For many planned procedures, surgery is delayed until the scar has matured and become more stable, which may take around a year. This is not an absolute rule: disabling contractures, risk to structures such as the eyelids, difficulty with eating or hygiene, persistent wounds, or other major functional problems may justify earlier treatment.

Yes. Releasing a contracture may improve mobility, while scar revision may also improve contour, texture or the way the treated area blends with surrounding tissue. The amount of improvement varies, and function takes priority when movement is restricted.

No. No technique can erase a scar completely. Surgery aims to replace, reposition or release the scar and reduce deformity or functional restriction, but it always creates a new scar whose final appearance depends on individual healing.

Yes. When several areas are involved or reconstruction is complex, treatment may be prioritised and performed in stages. Tissue expansion is also staged: an expander is inserted, the skin is gradually expanded, and the expanded skin is then used during a later operation.

Some tightening or recurrence can occur, particularly when a scar crosses a joint, when there is substantial tension, or while a child is growing. Follow-up, exercises, splints and other recommended rehabilitation measures help protect the result, but further surgery is sometimes required.

Risks vary with the technique and the area treated. They may include bleeding or haematoma, infection, delayed healing, wound separation, altered sensation, pain, an unfavourable scar, partial loss of a graft or flap, recurrent contracture and further surgery. Anaesthetic risks also apply when anaesthesia is used.

Fat is removed from another area by liposuction, prepared and injected in small amounts beneath the scar. The aim is to restore volume, and scar pliability or tissue quality may also improve. The evidence is promising, but results vary and not all transferred fat survives.

Possible effects include swelling, bruising, asymmetry or contour irregularity, infection, haematoma, oil cysts and fat necrosis. Some of the transferred volume may be reabsorbed, so additional sessions may be needed. Specific risks depend on both the donor site and the treated area.

An inflatable expander is placed beneath healthy skin near the scar and gradually filled over a series of visits. Once enough skin has been created, the expander is removed and the expanded skin is used to replace the selected scarred area. Risks include pain, infection, exposure or failure of the expander, skin problems, inadequate expansion and the need to stop or repeat treatment.

Stop the burning process and cool the area immediately under cool or lukewarm running water for about 20 minutes. Remove rings, watches and loose clothing before swelling develops, but do not pull away anything stuck to the skin. Do not use ice, butter, toothpaste or creams, and do not burst blisters. After cooling, cover the area loosely with a clean, non-adherent material and keep the rest of the body warm. Seek urgent medical care for large or deep burns, burns affecting the face, hands, feet, genitals or major joints, chemical or electrical burns, or possible smoke inhalation; call 112 in an emergency in Portugal.