Wound contracture is a tightening of the skin that can occur as a complication of the healing process. This process can sometimes go too far, causing the skin and underlying tissues to pull together excessively. This tightening can lead to issues that affect a person’s appearance and their ability to move. Understanding how contractures form is an important step in managing this condition.
How Wound Contractures Develop
The formation of a wound contracture is rooted in the normal stages of healing. When skin is injured, the body initiates a response that includes inflammation, tissue formation, and remodeling. A specialized cell type called the myofibroblast gathers at the wound site and actively pulls the edges of the injury closer together. This action, known as wound contraction, is a standard part of healing that reduces the size of the damaged area.
This process becomes problematic when myofibroblasts do not stop their work after the wound has closed. In a normal healing scenario, these cells undergo programmed cell death once the skin surface is repaired. However, in cases that lead to contracture, myofibroblasts persist and continue to exert force on the surrounding tissue. This sustained pulling is compounded by the excessive production and disorganized arrangement of collagen.
The result is scar tissue that is much tighter and less flexible than normal skin. This new tissue shrinks and pulls inward, leading to a permanent shortening of the skin and underlying structures. Unlike the temporary contraction of a healing wound, this state creates a fixed deformity. The scar tissue can take up to two years to fully mature.
Factors Increasing Contracture Risk
Certain conditions and types of injuries elevate the likelihood of developing a wound contracture. Deep and extensive burns are among the most common precursors, largely because of the tissue loss and prolonged inflammatory response they cause. Wounds over or near joints—such as on the hands, elbows, or knees—are particularly susceptible because movement and tension in these areas can promote excessive scarring.
The duration of the healing process is another factor. Wounds that take longer than three weeks to heal are at a higher risk of forming contractures. Chronic wounds or those that become infected trigger a prolonged inflammatory state, which leads to sustained activity of myofibroblasts and greater collagen deposition. This contributes to the development of tight, restrictive scar tissue.
Patient-specific characteristics can also play a part. Individuals with darker skin tones, as well as those of Asian or red-haired descent, may have a higher predisposition to forming severe scars. Any underlying health issue that impairs the body’s ability to heal or manage inflammation can further complicate the process.
Identifying Contractures and Their Impact
The signs of a developing wound contracture can range from subtle to obvious. Initially, the healed area might appear puckered or feel unusually tight. As the condition progresses, this tightening becomes more pronounced, leading to visible thickening of the scar tissue. A common symptom is a feeling of stiffness or a reduction in the flexibility of the skin.
These physical changes often translate into functional limitations. When a contracture forms over a joint, it can physically restrict the joint’s range of motion, making everyday activities challenging. Simple tasks like bending a finger or extending an elbow can become difficult. This loss of mobility may lead to muscle weakness and changes in how a person moves.
Beyond the physical limitations, contractures can have a considerable cosmetic impact, especially when they occur on visible areas like the face or hands. The altered appearance of the skin can affect a person’s self-esteem and body image.
Treatment Approaches for Wound Contractures
Managing an established wound contracture requires an approach aimed at releasing the tightened tissue and improving function. Treatment strategies are categorized as non-surgical or surgical. Non-surgical options are the first line of defense, especially for less severe or newly formed contractures.
Physical and occupational therapy are central to non-surgical management. These therapies involve targeted stretching exercises and range-of-motion activities to lengthen the contracted tissues. Therapists may also use splints or casts to hold a joint in a stretched position, encouraging the scar tissue to relax and elongate. Pressure garments, silicone gel sheets, and injections of corticosteroids are other tools used to soften scars and reduce inflammation.
When non-surgical methods are insufficient, surgical intervention may be necessary. Procedures like Z-plasty can release tension by reorienting the scar tissue. For more extensive contractures, a surgeon might remove the scarred tissue and replace it with a skin graft or a tissue flap. The choice of procedure depends on the location, severity, and functional impact of the contracture.
Strategies for Preventing Wound Contractures
Preventing the formation of wound contractures is an effective strategy, particularly for individuals with high-risk injuries. Proactive measures begin with timely wound care. Ensuring a wound is kept clean, properly dressed, and free from infection can shorten the healing time and reduce the inflammatory response that drives excessive scarring.
For wounds located over joints, early intervention is important. This includes guided range-of-motion exercises and specific positioning techniques to keep the healing skin stretched. Splinting is often used in burn care to maintain the length of the skin and prevent it from tightening as it heals.
Pressure therapy and silicone sheeting, often used to treat existing scars, can also be applied prophylactically to at-risk wounds to minimize scar formation. Adherence to medical advice and consistent attendance at follow-up appointments are important for monitoring the healing process.