ABOUT BURN CONTRACTURES
WHAT ARE BURN CONTRACTURES?
After a burn injury heals, scar tissue can thicken and tighten. When this restrictive scarring forms near or over a joint or feature, it can limit full movement, this is known as a burn contracture.
Contractures are largely preventable, yet studies show they still affect up to 80% of burn survivors, even in advanced burn services. By further research, understanding risk factors, and connecting people from all backgrounds, we can develop better prevention strategies and move toward a world free of burn contractures.
HOW DO CONTRACTURES FORM?
Burn injuries damage skin and sometimes underlying tissue. During healing, the body contracts wounds to close them, which reduces surface area. Some contraction is normal — but excessive scarring can occur.
Persistent activation of scar-forming cells (fibroblasts and myofibroblasts) can produce thick, tight tissue. When this happens near or over a joint or feature, it can lead to a contracture.
Many factors influence contracture risk throughout recovery; further research is needed to understand the complex micro and macro processes behind burn contracture formation and how this relates to known risk factors. With this knowledge we can develop effective preventative strategies to stop contractures.
RICK FACTORS FOR BURN CONTRACTURES
Contracture risk varies between individuals and settings. More research is needed to fully understand these risk factors, how they interact and what power they have in different people and settings.
Prevention and treatment must be tailored to each person’s journey. Reducing exposure to risk factors can improve quality of life, lessen the need for reconstructive surgeries, and prevent unnecessary pain and disability.
PATIENT FACTORS
Age, gender, ethnicity, occupation, socioeconomic status, family support, and pre-existing health conditions all influence contracture risk.
WHAT'S THE TREATMENT?
Although the aim is to prevent burn contractures, both surgical and non-surgical interventions can also treat existing ones.
Physical, occupational and rehabilitation therapies are central to prevention and management. Splinting and positioning maintain joints in “anti-contracture” positions — for example, extending the elbow to counter its tendency to contract in flexion. Active and passive exercises are essential to counteract scar contraction and maintain tissue length for full joint movement. Scar management techniques such as silicone gels, pressure garments and massage help keep scars soft and pliable. Functional activities should start as soon as possible, and rehabilitation begins on day one of injury. Because burns and scars are painful, pain management is often required to support movement and therapy.
If a contracture develops, surgery may release the scar to restore movement and appearance. Reconstruction can involve local flaps, skin grafts (with or without dermal substitutes) or more extensive flap transfers. In some countries, laser therapy is also used to improve scar quality and flexibility.
Contractures evolve over time. Regular monitoring by a doctor or therapist is crucial during the first one to two years after injury — and longer in children, since scars do not grow as the child grows and contractures can emerge years later.
HOW CAN THEY BE PREVENTED?
Burn injuries are complex, and preventing burn contractures requires a comprehensive, multidisciplinary approach.
Survivors need coordinated support addressing the medical, surgical, physical and psychosocial aspects of their injury. Effective first aid, early management, high-quality medical and surgical care, and long-term physical and psychosocial rehabilitation are all critical to recovery, contracture prevention and the overall wellbeing of burn survivors.
Contractures develop in the presence of multiple risk factors — many of them modifiable. Prevention strategies must involve early interventions for all people with burn injuries to prevent or reduce contracture formation. A clear understanding of risk factors such as timeliness of treatment, accessibility, patient education and the type of care delivered can reduce both the presence and severity of contractures. Prevention strategies also need to be adapted to context — especially when planning and implementing programmes in high- versus low-income countries. Because risk factors vary across settings, their influence and priority may differ, requiring tailored approaches and context-specific strategies to be most effective.