Hypertrophic Burn Scar Evolution and Management

Abstract

Burn injury outcome has improved significantly in recent years in relation to survival and patient rehabilitation. However, scarring and its accompanying aesthetic and functional sequelae still remain a major problem. The burn injury is characterized by unique differences in the nature of tissue trauma, the pathophysiologic response to that trauma and the molecular events that impact on the evolution of scar formation in these injuries. Some nuances in the burn injury profile have direct influence on scar outcome but have not been concentrated on in the past when designing treatment regimens for scar control. These include the exposed nerve endings, stimulation of neuropeptide mediators, neurogenic inflammation, pruritis, mechanotension signaling and hydration. A composite device for scar control in burn injuries should involve a multimodal approach that incorporates strategies for control of these contributing factors. A protective, hydrative, tension relieving device is predominant among the requirements, with substance impregnation being a secondary possibility in future renditions.