A contracture scar is a type of scar that causes the skin and underlying tissues to tighten, often leading to a noticeable restriction in movement. This form of scarring develops following an injury, where the body’s natural healing process results in the formation of dense, inelastic tissue. The primary impact of a contracture scar is on physical function, as the tightened tissue can pull on adjacent structures, limiting the normal range of motion in the affected area.
Formation and Common Causes
Contracture scars form during the body’s wound healing response after significant tissue damage. Specialized cells like myofibroblasts are activated, responsible for wound contraction. While this initial contraction is a normal part of healing, the process can become dysregulated, leading to excessive collagen production and persistent tightening. This results in dense, fibrotic tissue that lacks the elasticity of normal skin.
Severe injuries, such as second and third-degree burns, commonly cause contracture scars, especially when the wound takes longer than three weeks to heal. Large, open wounds or injuries over joints are also highly susceptible. Areas like the knees, elbows, fingers, and neck are vulnerable because constant movement can repeatedly stress healing tissue, prompting a more rigid scar response. This continuous tightening can significantly limit movement.
Identifying a Contracture Scar
Identifying a contracture scar involves observing its functional impact. A person will experience tightness in the affected region, leading to a limited range of motion. This restriction might manifest as difficulty fully straightening a finger, extending an arm, or turning the neck. Unlike a typical scar, the defining characteristic of a contracture scar is this functional impairment and inability to move the affected body part through its full range.
Beyond functional limitations, contracture scars also present with distinct physical characteristics. The skin in the scarred area often appears puckered, tight, and noticeably thickened. It may feel firm or rigid to the touch, lacking the pliability of healthy skin. This combination of visual changes and tangible restriction of movement indicates a developing or established contracture scar.
Medical and Therapeutic Interventions
Addressing an existing contracture scar often involves medical and therapeutic approaches to restore function and reduce tightness. Non-invasive interventions begin with physical and occupational therapy, using stretching exercises to gradually lengthen tightened tissues. These exercises maintain the length of skin and soft tissues, often held for several minutes to encourage relaxation. Therapists also use splinting or casting techniques to hold the affected area in a stretched position, continuously elongating scar tissue. Pressure garments apply consistent pressure to help flatten and soften the tissue, reducing its tendency to contract.
For more severe contractures, medical procedures are used. Steroid injections can be administered directly into the scar tissue to reduce inflammation and break down excess collagen, making the scar softer and more pliable. When non-surgical methods are insufficient, surgical interventions release tightened tissue. Z-plasty is a common technique involving Z-shaped incisions to reorient the scar and lengthen the skin, releasing tension. Other flap surgeries move healthy skin and underlying tissue from an adjacent area to cover the defect. In cases of extensive scarring or significant tissue loss, skin grafting replaces damaged, contracted skin.
Prevention and Management During Healing
Preventing contracture scars begins immediately after an injury, focusing on proper wound care and early intervention. Following a doctor’s instructions for wound management is important to minimize complications that can lead to excessive scarring. This includes keeping the wound clean and protected to prevent infection, which can prolong inflammation and contribute to scar development.
Early and consistent movement of the injured area, as advised by a healthcare professional, is important in preventing contractures. Prescribed physical therapy exercises during healing help keep skin and joints flexible, discouraging excessive tightening. Scar tissue tightens continuously, so consistent stretching and movement counteract this natural tendency. In severe burns, early excision of damaged tissue and timely skin grafting can significantly reduce contractures by providing a healthier skin layer less prone to contraction.