Secondary effects of burn scar on the growing skeleton
Savita Arora1, SP Bajaj2, JS Kohli3 1 Senior resident 2 Consultant and Head of the Department 3 Senior resident Deptt. of burns plastic & maxillofacial surgery, Safdarjung Hospital, New Delhi, India
S P Bajaj Consultant and Head of the Department
Source of Support: None, Conflict of Interest: None
Severe growth retardation and reduced thickness of bones and joints is a common finding resulting from burn contracture which persists even after the release of contracture. Cutaneous scar contracture alone is not responsible for these skeletal changes but reduced blood supply to bones and joints due to trauma or scar tissue leads to restriction of growth. Wherever there has been continuous pull from scar, it leads to increased flow of blood. At these sites there was excessive new bone formation and hyperplasia of the bone, but in our study it was seen that the thickness of the bone was reduced in all the cases. Burn scar contracture did not always led to growth retardation as it was observed in just six cases. It was observed that these changes i.e. growth retardation and thinning oi bone could not be reversed when the pulling force of scar tissue was removed by release and split skin grafting as studied in fourteen cases. Encouraged by this observation we tried to find out the cause of bone atrophy and we found in our study that these effects are reversed when by any means along with the release of pulling force vascularity of the part is increased, though there was not much change in the length of the bone. The effects are normally unpredictable but they are seen maximum when scar formation is seen during infancy and remain uncorrected for more than five years.