Splinting, physiotherapy and the timing that decides whether a release holds.
A burn contracture is a tight band of scar that pulls a joint out of position, bending a neck towards the chest, clamping an arm to the side, or curling fingers into the palm. Surgery can release the band and restore movement, but the scar biology that created the contracture does not switch off on the operating table. Understanding that is the difference between a release that lasts and one that quietly fails over six months.
Every healing wound shrinks; that is part of normal biology. A deep burn that heals slowly, without grafting, produces scar tissue that keeps contracting for six to twelve months after the skin looks closed. When that scar crosses a joint, the shrinkage becomes a contracture. Children are affected worst, because their scars must also keep up with growth.
A release divides or removes the scar band and fills the gap with living tissue, a skin graft, a local flap, or sometimes tissue moved from further away. The choice matters: releases resurfaced with thin grafts contract more than those covered with thicker grafts or flaps. That choice is made joint by joint, and it is one reason two releases of the same joint can behave very differently.
After a release, the joint is splinted in the corrected position while the new cover heals and matures. Splints are typically worn full time at first, then at night, for a schedule that runs months, not weeks. Families often stop splinting when the wound looks healed. The scar keeps contracting long after it looks quiet, which is exactly the period when the splint is doing its most important work.
Physiotherapy keeps the released joint moving through its full range every day. Movement stretches the maturing scar and stops it re tethering; missed therapy weeks show up later as returning tightness. Pressure garments and silicone are added where the scar is active, softening it as it matures.
Recurrence is not the end of the road. A recurrent contracture can be released again, usually with more durable cover and a stricter rehabilitation plan, and results remain good. But the honest lesson from every recurrence is the same: the operation is one afternoon, and the outcome is decided across the following year.
Any burn scar that limits movement, pulls a feature, cracks open repeatedly, or is tightening as a child grows deserves surgical review, whether the burn was last year or twenty years ago. Old contractures are treated successfully all the time; nothing about a long standing band makes it untreatable.
Usually for months, tapering as the scar matures. The exact schedule is written for each joint, and stopping early is the commonest reason a release fails.
It is uncomfortable at first, and it is also the part of treatment that decides the result. Therapy is graded so the release stretches without damaging the repair.
Yes. A recurrence can be re released, usually with flap or graft cover and a stricter rehabilitation plan, and the result can still be excellent.
Scar tissue does not stretch at the same rate as growing skin and bone, so an area that was adequate at one age can become tight again. Children are therefore reviewed periodically until growth is complete.
Short sessions several times a day, holding a slow steady stretch to the point of tension rather than pain, are more effective than one long painful session. Your therapist sets the specific positions for the joints involved.
Pressure garments and silicone are commonly used on healing burn scars to keep them flatter and more supple, and they are worn for extended periods to be useful. Fit is checked as the scar and the child change.
When a scar limits a joint despite consistent therapy, interferes with function or growth, or keeps breaking down, release is considered. Therapy still continues after surgery, since it protects the gain.
