Surgery for Disfiguring Scars and Contractures After Burns and Trauma
When a scar feels less tight and stops pulling, you can move more freely, wear what you like again, and spend a little less of each day thinking about it.
Is this right for you?
A contracture is a thick, tight band of scar tissue that pulls on the skin and sometimes draws a nearby joint to one side, making it hard to straighten out or move through a full range. Surgery suits some situations and not others, and a consultation helps work out whether yours is one of them.
This may be a good fit if
- You have a tight scar pulling across a joint (neck, armpit, elbow, hand, or knee) that limits how you move or feels uncomfortable when you do.
- Your scar has settled, usually around 12 months after the wound healed, and it is no longer bright red or changing from week to week.
- You have a keloid, a raised (hypertrophic) scar, or a sunken scar that bothers you in how it feels or how it looks.
- You are healthy enough overall to come through surgery and the healing that follows, and you do not smoke, or you are willing to stop before and after the operation.
- You understand that the aim is to improve how the area works and to make the scar less obvious, not to erase it completely.
This may not be right if
- Your scar is still new, still red, and in the middle of healing; at this stage it is usually wiser to wait and watch a while longer.
- You have an active infection in the area, an open wound that has not closed, or a condition such as poorly controlled diabetes that slows healing.
- You expect the skin to look exactly as it did before the injury; surgery cannot return skin to the way it was.
- You are pregnant or breastfeeding, or you are at a point in life where you cannot set aside time to rest and recover.
How it works
Everything starts with a consultation. Your surgeon looks closely at the scar, asks when and how the injury happened, checks your range of motion if the scar sits near a joint, and listens for what troubles you most, whether that is the tightness, the shape, the colour, or how hard it is to move. From there, the two of you talk through whether one technique or a combination makes the most sense.
Depending on how severe the scar is and where it sits, your surgeon may choose from several approaches. For a contracture, a common technique is to make Z-shaped cuts (Z-plasty) that rotate and lengthen the tissue, releasing the tension. Where a lot of skin is missing, your surgeon may need a skin graft (taking a thin layer of skin from another part of your body) or a flap (moving a patch of skin that keeps its own blood supply from a nearby area). In some cases, a tissue expander is placed to grow extra healthy skin before the scar is removed.
The type of anaesthesia depends on the size and location. A small scar may be treated under local anaesthesia; larger areas, those near a joint, or those needing a graft usually call for general or regional anaesthesia. Your surgeon will explain the choice for your situation.
During surgery, your surgeon removes or releases the scar tissue that is pulling, rearranges the skin to ease the tension, and closes the wound in a way that limits new scarring. If a graft or flap is needed, your surgeon secures it and applies a firm dressing so it takes well. Some cases call for more than one stage, spaced a few months apart.
Realistic expectations
Scar surgery is about improvement, not erasure. Holding that line in your mind helps you decide with a clearer head and feel more at ease with the result.
What this will not do
- It will not make the scar disappear completely; the goal is a scar that is flatter, softer, less tight, and less noticeable.
- It will not return your skin to how it was before the burn or injury.
- It will not guarantee that your full range of motion comes back, though many people do move more easily once a scar is released.
- It will not replace physiotherapy, sunscreen, and long-term scar care, all of which have a large say in the final outcome.
Recovery
Recovery shifts with the extent of surgery, where the scar sits, and whether a graft was used. The stages below are rough estimates to help you picture the path, not fixed numbers.
- The first few days
- The surgical area is usually swollen, bruised, and sore; you take pain relief as prescribed. If you had a graft, both the donor area and the treated area are kept under firm dressings and need to stay still.
- Around 1 to 2 weeks
- Stitches come out or the wound is reviewed during this window. Many people return to light, undemanding work, depending on where the scar is and what their job involves.
- Around 2 to 6 weeks
- Swelling settles gradually. If the scar sits near a joint, your surgeon usually guides you through exercises or physiotherapy to hold and build your range of motion and keep the contracture from returning.
- Around 3 to 12 months
- The scar keeps softening and fading. You may be guided to use silicone sheets, massage the scar, wear a pressure garment, or protect it carefully from the sun. The final look takes a long stretch of time to settle.
Risks & safety
Every operation carries risk. You should know the following so you can weigh it up with your surgeon before you decide.
- A new scar forms along the incision, and in some cases the scar can become thick, raised, or tight again.
- Infection, bleeding, or a collection of fluid in the surgical area.
- A skin graft or flap that does not take well, in part or in full, sometimes needing further treatment.
- Differences in colour, thickness, or surface texture between the treated area and the surrounding skin.
- Numbness, itching, or more or less sensation in the surgical area and the donor site.
- A result that falls short of what you hoped for, which may call for additional surgery.
- Risks tied to anaesthesia, which vary with your health and the type used.
How we do it
At The Gioi Dep, our surgeons approach contractures and burn scars with a balance between function and appearance. Your surgeon weighs both your range of motion and the look of the area, plans for the specific part of the body involved, and speaks plainly about what surgery can and cannot do, so you can decide on clear information.
Because scars need care over the long term, the hospital pays close attention to the period after surgery: guidance on scar massage, silicone, sun protection, and movement exercises when the scar sits near a joint. You are given follow-up appointments so your surgeon can watch the scar mature and adjust the plan when needed.
Frequently asked questions
Will surgery make the scar disappear completely?
No. No method removes a scar entirely. The aim is to make the scar flatter, softer, less tight, and less visible, and to improve movement if the scar sits near a joint.
Does it hurt?
You do not feel pain during the operation, thanks to the anaesthesia. Afterward there is usually soreness and a tight feeling for the first few days, managed with pain relief as prescribed. How much depends on the extent of surgery.
How long do I need off work?
It depends on where the scar is and what your job involves. Many people return to light work within about 1 to 2 weeks, though work that needs heavy effort or use of the area just operated on may mean a longer break. Your surgeon will advise for your situation.
How long should I wait after a burn or injury before surgery?
A scar usually needs to settle before any work is done, often around 12 months after the wound healed. That said, if a contracture is severely limiting your movement, your surgeon may consider operating sooner.
Will the result look natural?
Your surgeon rearranges the skin and places the incision so the scar blends into the surrounding area as much as possible. The treated area may still differ slightly in colour or texture, and the scar will keep softening and fading over time.
What is a skin graft, and what does it leave at the area it is taken from?
A skin graft takes a layer of skin from another part of the body to cover where skin is missing. The donor area has a new wound that heals over time and leaves a scar of its own. Your surgeon usually chooses a donor area that is less on show.
Can the scar tighten again after surgery?
It can. Scars tend to contract as they heal. That is why movement exercises, silicone, a pressure garment, and follow-up as guided matter so much in keeping the contracture from coming back.
Am I too old for this?
Age on its own is not the deciding factor. What matters is your overall health and your ability to heal the wound. Your surgeon will assess your condition to see whether surgery is safe and sensible for you.
Will I need more than one operation?
Some large or complex scars need more than one stage, spaced a few months apart, for example when the skin has to be expanded first and the scar removed afterward. Your surgeon will talk through the specific plan with you from the start.
The next step
The next step is a conversation - book a consultation.
The content on this page is for reference only and does not replace a direct examination and consultation with a specialist physician. Surgical outcomes vary from person to person.