Hand clinics
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Hypertrophic scar and contracture in burn patients is a complex process. Contributing factors include critical injury depth and activation of key cell subpopulations, including deep dermal fibroblasts, myofibroblasts, fibrocytes, and T-helper cells, which cause scarring rather than regeneration. ⋯ These cells also both modify and interact with extracellular matrix of the wound, ultimately forming hypertrophic scar. Current treatments reduce hypertrophic scar formation or improve remodeling by targeting these pathways and signals.
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Postburn contractures are a common occurrence after severe burn injuries. It is important to understand the pathologic condition and anatomy of specific postburn deformities in order to provide comprehensive surgical care. ⋯ Surgery sequences require proper incision design, release of the skin, and deeper contracted structures and coverage with an appropriate flap or graft. Postoperative splinting, scar care, and therapy are equally important for a successful outcome.