Contractures

Contractures

Scar contractures can cause severe functional, psychological and aesthetic problems ( Figure 3.19 ). Contractures across joints may restrict the range of movement, leading to deformity , - impairment and disability . Contractures may also result from the di ff erential growth pattern between scar and surrounding tissues. - Surgical contracture r elease and reconstruction can be an e ff ective treatment option. A key principle is the replacement of scar tissue with healthy tissue. A wide range of r econstruc - tions are described ( Summary box 3.4 ) and typically involve 14 skin grafts or flaps (more information can be found in Part 6 ). - Local flaps suc h as Z-plasty ( Figure 3.20 ) and its variants can be used to lengthen and transpose the scar. Many other local flaps have been described, including Y–V , V–Y and W-plasty . Free flaps may be required for resurfacing sever e contractures. In general, flaps are preferable to skin grafts because of - graft contracture. When skin grafts are used, full thickness is preferred to split thickness as they have a better texture and contract less during healing.

(red/raised) (dark/raised) Intralesional corticosteroids Silicone gel/sheeting + a intralesional corticosteroids 5-FU + intralesional corticosteroids b Fractional or pulsed-dye laser therapy Patient counselling regarding reccurence rate and expectations Surgical excision with adjuvant • Silicone gel or sheeting or intralesional corticosteroids or both • Radiotherapy • Alternative therapies (bleomycin, mitomycin C, imiquimod) Figure 3.18 Management algorithm for keloids. Light grey indicates initial management strategies; dark grey indicates secondary man a agement options. Cryotherapy may be used in conjunction with intralesional corticosteroids, depending on physician experience and b comfort with its application. Ablative fractional lasers are the pre ferred initial laser therapy option for patients with minor keloids. 5-FU, 5- /f_l uorouracil. (Redrawn with permission from Gold MH, McGuire M, Mustoe TA et al . Updated international clinical recommendations on scar management: part 2–algorithms for scar prevention and treat ment. Dermatol Surg 2014; 40 (8): 825–31.)

Contractures

Scar contractures can cause severe functional, psychological and aesthetic problems ( Figure 3.19 ). Contractures across joints may restrict the range of movement, leading to deformity , - impairment and disability . Contractures may also result from the di ff erential growth pattern between scar and surrounding tissues. - Surgical contracture r elease and reconstruction can be an e ff ective treatment option. A key principle is the replacement of scar tissue with healthy tissue. A wide range of r econstruc - tions are described ( Summary box 3.4 ) and typically involve 14 skin grafts or flaps (more information can be found in Part 6 ). - Local flaps suc h as Z-plasty ( Figure 3.20 ) and its variants can be used to lengthen and transpose the scar. Many other local flaps have been described, including Y–V , V–Y and W-plasty . Free flaps may be required for resurfacing sever e contractures. In general, flaps are preferable to skin grafts because of - graft contracture. When skin grafts are used, full thickness is preferred to split thickness as they have a better texture and contract less during healing.

(red/raised) (dark/raised) Intralesional corticosteroids Silicone gel/sheeting + a intralesional corticosteroids 5-FU + intralesional corticosteroids b Fractional or pulsed-dye laser therapy Patient counselling regarding reccurence rate and expectations Surgical excision with adjuvant • Silicone gel or sheeting or intralesional corticosteroids or both • Radiotherapy • Alternative therapies (bleomycin, mitomycin C, imiquimod) Figure 3.18 Management algorithm for keloids. Light grey indicates initial management strategies; dark grey indicates secondary man a agement options. Cryotherapy may be used in conjunction with intralesional corticosteroids, depending on physician experience and b comfort with its application. Ablative fractional lasers are the pre ferred initial laser therapy option for patients with minor keloids. 5-FU, 5- /f_l uorouracil. (Redrawn with permission from Gold MH, McGuire M, Mustoe TA et al . Updated international clinical recommendations on scar management: part 2–algorithms for scar prevention and treat ment. Dermatol Surg 2014; 40 (8): 825–31.)

Contractures

Scar contractures can cause severe functional, psychological and aesthetic problems ( Figure 3.19 ). Contractures across joints may restrict the range of movement, leading to deformity , - impairment and disability . Contractures may also result from the di ff erential growth pattern between scar and surrounding tissues. - Surgical contracture r elease and reconstruction can be an e ff ective treatment option. A key principle is the replacement of scar tissue with healthy tissue. A wide range of r econstruc - tions are described ( Summary box 3.4 ) and typically involve 14 skin grafts or flaps (more information can be found in Part 6 ). - Local flaps suc h as Z-plasty ( Figure 3.20 ) and its variants can be used to lengthen and transpose the scar. Many other local flaps have been described, including Y–V , V–Y and W-plasty . Free flaps may be required for resurfacing sever e contractures. In general, flaps are preferable to skin grafts because of - graft contracture. When skin grafts are used, full thickness is preferred to split thickness as they have a better texture and contract less during healing.

(red/raised) (dark/raised) Intralesional corticosteroids Silicone gel/sheeting + a intralesional corticosteroids 5-FU + intralesional corticosteroids b Fractional or pulsed-dye laser therapy Patient counselling regarding reccurence rate and expectations Surgical excision with adjuvant • Silicone gel or sheeting or intralesional corticosteroids or both • Radiotherapy • Alternative therapies (bleomycin, mitomycin C, imiquimod) Figure 3.18 Management algorithm for keloids. Light grey indicates initial management strategies; dark grey indicates secondary man a agement options. Cryotherapy may be used in conjunction with intralesional corticosteroids, depending on physician experience and b comfort with its application. Ablative fractional lasers are the pre ferred initial laser therapy option for patients with minor keloids. 5-FU, 5- /f_l uorouracil. (Redrawn with permission from Gold MH, McGuire M, Mustoe TA et al . Updated international clinical recommendations on scar management: part 2–algorithms for scar prevention and treat ment. Dermatol Surg 2014; 40 (8): 825–31.)