# Delayed reconstruction and scar management Delayed reconstruction and scar management Delayed reconstruction of burn injuries is common for large full-thickness burns. These techniques were pioneered by McIndoe and Gillies. In the early healing period, acute contractures around the eye need particular attention. Eyelids must be grafted at the first sign of di ffi culty in closing the eyelids, and this must be done before the patient has any symptoms of exposure keratitis. Other areas that require early intervention are any contracture causing significant loss of range of movement of a joint. This is particularly important in the hand and axilla. An established contracture can be treated in a number of ways. Burn alopecia is best treated with tissue expansion of the unburned hair-bearing skin. Tissue expansion is also a use - ful technique for isolated burns and other areas with adjacent nor mal skin. Z-plasty is useful where there is a single band and a transposition flap is useful in wider bands of scarring ( Figure 46.11 ). In areas of circumferential or very broad ar eas of scarring, the only real treatment is incision and replacement with tissue. By far the best tissue for replacement is from either a full-thickness graft, dermal substitute with split-skin graft or vascularised tissue as in a free flap. Summary box 46.18 Delayed reconstruction of burns /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - Eyelids must be treated before exposure keratitis arises Transposition /f_l aps and Z-plasties with or without tissue expansion are useful Full-thickness grafts and free /f_l aps may be needed for large or dif /f_i cult areas Hypertrophy is treated with pressure garments Pharmacological treatment of itch is important ments. These need to be worn for a period of 6–18 months. Where it is di ffi cult to apply pressure with pressure garments, or with smaller areas of hypertrophy , silicone patches will speed scar ma turation, as will intralesional injection of steroid. Itching and dermatitis in burn scar areas are common. Pharmacological treatment of itch is an essential adjunct to therapy . Delayed reconstruction and scar management Delayed reconstruction of burn injuries is common for large full-thickness burns. These techniques were pioneered by McIndoe and Gillies. In the early healing period, acute contractures around the eye need particular attention. Eyelids must be grafted at the first sign of di ffi culty in closing the eyelids, and this must be done before the patient has any symptoms of exposure keratitis. Other areas that require early intervention are any contracture causing significant loss of range of movement of a joint. This is particularly important in the hand and axilla. An established contracture can be treated in a number of ways. Burn alopecia is best treated with tissue expansion of the unburned hair-bearing skin. Tissue expansion is also a use - ful technique for isolated burns and other areas with adjacent nor mal skin. Z-plasty is useful where there is a single band and a transposition flap is useful in wider bands of scarring ( Figure 46.11 ). In areas of circumferential or very broad ar eas of scarring, the only real treatment is incision and replacement with tissue. By far the best tissue for replacement is from either a full-thickness graft, dermal substitute with split-skin graft or vascularised tissue as in a free flap. Summary box 46.18 Delayed reconstruction of burns /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - Eyelids must be treated before exposure keratitis arises Transposition /f_l aps and Z-plasties with or without tissue expansion are useful Full-thickness grafts and free /f_l aps may be needed for large or dif /f_i cult areas Hypertrophy is treated with pressure garments Pharmacological treatment of itch is important ments. These need to be worn for a period of 6–18 months. Where it is di ffi cult to apply pressure with pressure garments, or with smaller areas of hypertrophy , silicone patches will speed scar ma turation, as will intralesional injection of steroid. Itching and dermatitis in burn scar areas are common. Pharmacological treatment of itch is an essential adjunct to therapy . Delayed reconstruction and scar management Delayed reconstruction of burn injuries is common for large full-thickness burns. These techniques were pioneered by McIndoe and Gillies. In the early healing period, acute contractures around the eye need particular attention. Eyelids must be grafted at the first sign of di ffi culty in closing the eyelids, and this must be done before the patient has any symptoms of exposure keratitis. Other areas that require early intervention are any contracture causing significant loss of range of movement of a joint. This is particularly important in the hand and axilla. An established contracture can be treated in a number of ways. Burn alopecia is best treated with tissue expansion of the unburned hair-bearing skin. Tissue expansion is also a use - ful technique for isolated burns and other areas with adjacent nor mal skin. Z-plasty is useful where there is a single band and a transposition flap is useful in wider bands of scarring ( Figure 46.11 ). In areas of circumferential or very broad ar eas of scarring, the only real treatment is incision and replacement with tissue. By far the best tissue for replacement is from either a full-thickness graft, dermal substitute with split-skin graft or vascularised tissue as in a free flap. Summary box 46.18 Delayed reconstruction of burns /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - Eyelids must be treated before exposure keratitis arises Transposition /f_l aps and Z-plasties with or without tissue expansion are useful Full-thickness grafts and free /f_l aps may be needed for large or dif /f_i cult areas Hypertrophy is treated with pressure garments Pharmacological treatment of itch is important ments. These need to be worn for a period of 6–18 months. Where it is di ffi cult to apply pressure with pressure garments, or with smaller areas of hypertrophy , silicone patches will speed scar ma turation, as will intralesional injection of steroid. Itching and dermatitis in burn scar areas are common. Pharmacological treatment of itch is an essential adjunct to therapy .