How can scar contractures be prevented after a burn?

What is a burn scar contracture?

As burn wounds heal, scar tissue forms and naturally contracts. When scars cross joints or cover large areas, this contraction can pull the skin tight and restrict movement, a problem known as a scar contracture. Contractures can make it difficult to move the neck, open the hand, lift the arm or straighten the knee.

Deeper burns, burns that take longer to heal and burns needing skin grafts are more likely to form thick, tight scars.

How common are contractures after burns?

A systematic review found that the prevalence of burn scar contractures at hospital discharge ranged from 38 to 54 per cent across studies, and was lower with longer time after the burn 1.

Contractures were more likely after more severe burns and flame burns, in children and women, and at the neck and upper limbs 1. Prevalence varied considerably between studies.

Why does positioning matter?

People with burns naturally rest in positions of comfort, which are often the positions that allow scars to shorten, for example bending the neck forward, bringing the arms close to the body or curling the fingers. Positioning the body to keep burned areas stretched counteracts this.

International burn care practice guidelines from the International Society for Burn Injury include recommendations on rehabilitation, including positioning, splinting and exercise, for both well-resourced and resource-limited settings 2.

How do splints help?

Splints hold joints in positions that keep the skin stretched, particularly at night and during periods of rest. Common splints include those that keep the hand open with the knuckles bent and fingers straight, and neck collars that keep the neck extended.

Splints are made or adjusted by therapists and checked regularly to prevent pressure injuries and to adapt as healing progresses.

Why is early movement important?

Moving joints through their full range of movement several times a day, starting as soon as medically safe, maintains flexibility, prevents stiffness and preserves muscle strength. Everyday activities, such as eating, dressing and washing, are encouraged as part of rehabilitation.

Exercise may be uncomfortable, so pain relief is often timed before therapy sessions. Children may need play-based therapy to encourage movement.

How long do scars take to mature?

Scars continue to change for many months, often a year or more, becoming paler, softer and flatter as they mature. During this time, the risk of contracture remains, so stretching, positioning and scar management continue.

Growth in children can cause scars to tighten over time, so children with burns need follow-up as they grow.

How can families help at home?

After discharge, much of the work to prevent contractures happens at home. Families can help by encouraging regular stretching, reminding the person to wear splints as instructed, and supporting positions that keep healing skin stretched, for example avoiding long periods with the neck bent forward over a phone or with the elbows bent. Keeping a simple daily chart of exercises and splint wear makes routines easier to follow.

For children, turning stretches into games, songs or reaching activities makes practice more enjoyable. Families should also watch for skin breakdown under splints, new tightness or reluctance to move a joint, and report these early to the burns therapy team.

What if a contracture develops?

Contractures may respond to intensive stretching, serial casting or splinting. If movement remains limited and affects function, reconstructive surgery such as scar release with skin grafts or flaps may be considered, followed by further rehabilitation.

Seek advice early if you notice reduced movement, tightening skin, pain or difficulty with daily tasks.

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