The arm won’t lift
A scar in the armpit prevents lifting the arm up or moving it to the side.
CONDITION / SKIN AND SCARS
Post-burn contracture.
Post-burn contracture is a condition where a scar from a burn tightens the skin and prevents fully raising the arm, straightening the elbow, fingers, or knee. The scar band is either cut or excised, the skin deficit is covered, and after surgery, splints and rehabilitation exercises with a specialist are necessary.
CONCEPTUAL VISUALIZATION- What it is
- A burn scar tightens the skin over a joint and limits movement.
- How common
- According to a review of 327 publications, contracture occurs in about a third of people who have survived a burn.
- Where it happens
- The upper limb and neck are most frequently described; in children — the shoulder and elbow.
- How we treat
- The scar band is dissected or excised, and the skin deficit is covered; then splints and rehabilitation follow.
01 / WHAT IS ITWhat is
What is
Post-burn contracture.
After a deep burn, the wound heals with a scar. Over time, the scar contracts and becomes less elastic than normal skin. If it is located over a joint — in the armpit, at the elbow flexion, on the wrist, fingers, under the knee, or on the foot — it tightens the skin and prevents fully straightening the joint or raising the arm. This is a contracture.
According to the NHS definition, a contracture scar feels tight, it is difficult or painful to move in that area, and it usually occurs after a burn. According to a systematic review, limited joint movement can interfere with everyday activities — for example, dressing or washing.
This page is about contractures of the trunk and limbs: armpits, elbow, wrist, hand, knees, feet. For tightening on the face and neck — see the separate page "Post-burn scar contractures of the face and neck." If movement is limited after an injury without a burn — see "Post-traumatic contracture."
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow
How
contracture presents.
A contracture may be a narrow band or a broad stiff area of a scar. This determines how it is treated.
The elbow or knee won’t straighten
A scar at the bend keeps the joint bent, and it is impossible to fully straighten it.
Fingers and hand
Fingers do not straighten or spread, difficult to grasp an object or open the hand.
Post-traumatic contractureLump under the skin
During movement, the scar stretches like a string, turns white, and pulls.
Itching and pain
According to the NHS, a scar may itch, hurt, or cause discomfort.
Hypertrophic scarWounds on the scar
Scar over a joint cracks, weeps, or develops wounds that do not heal — such an area should be shown to a doctor.
Unstable scar03 / REASONSWhy does it occur?
Why does it occur?
contracture
Contracture is a consequence of excessive scarring and constant contraction of the scar.
Depth and area of the burn
According to systematic review, contractures are more common after more severe burns and flame burns.
Burn location
According to the same review, the neck and upper limb are more often affected, and contractures are also more common in children and women.
Children
In a study of 1031 children with major burns, 23% had at least one contracture at the time of discharge. Most often — the shoulder (27.9%) and elbow (17.6%). The authors note that as the child grows, there may be more contractures.
How often after discharge
According to a systematic review, at the time of discharge, contracture was present in 38–54% of patients, and over time after the burn — in a smaller proportion. The study data vary greatly.
04 / SEEK MEDICAL ADVICE
When to seek urgent medical care?
An old contracture — a planned situation: it usually does not require emergency care. A fresh burn should be immediately cooled with cool running water for 20 minutes. Medical care is needed if the burn just occurred and it is serious, or if signs of severe infection appear.
103 immediately if:
- the burn just occurred, and it is very large or deep;
- fresh burn on the face, genital area, or buttocks;
- burn from acid, another chemical substance, or electricity;
- breathing very frequently or difficulty breathing;
- sudden confusion, unclear speech, person speaks illogically;
- blue, pale, or mottled skin or lips;
- a rash that does not fade if you press on it;
- person does not respond or has fainted.
Other levels of urgency:
Immediately - to the surgeon who operated, and if it does not work - to the reception department: after surgery, pain or swelling at the operation site increases rapidly; the transplanted flap has changed color (pale, blue, or darkened) or has become cold. On the same day: fresh small burn, if you do not know how to treat it, or if it is in a child under 5 years old — consult a doctor; a scar or wound after surgery has become red, painful, hot to touch, or is oozing pus — see a doctor the same day. In the coming weeks: a sore or area on an old scar is painful, itchy, bleeding, or forming a scab for more than 4 weeks or is growing and changing color — see a doctor. Planned: A scar tightens the skin and restricts movement, hurts or interferes with life — consult a plastic surgeon.
05 / DIAGNOSTICSHow to evaluate
How to evaluate
contracture
- Conversation
When the burn occurred, how it was treated, which surgeries have already been performed, what interferes the most: movement, pain, itching, or appearance.
- Scar examination
The surgeon assesses whether it is a narrow band or a wide stiff area, what the surrounding skin is like, and where tissue can be taken from.
- Range of motion
They measure how much the joint bends and straightens, and how this interferes with daily activities.
- Documents and photos
Discharge summaries from the burn unit, photos of scars in motion; for the hand — evaluation of grip and fine movements.
- Related specialists
The rehabilitation specialist evaluates movement and strength; hand and foot contractures — together with the 'Restoration of the Hand and Foot' track.
06 / TREATMENTHow we treat
How we treat
contracture
The goal of treatment is to restore movement and function, and only then improve appearance. There is no consensus on when to choose which method: according to a systematic review, there are few studies and they are of low quality, so the approach is selected individually.
01
Release of the joint
What is done with the scar itself.
- Z-plasty
- A narrow linear band is cut and the skin is redistributed with local flaps. According to the review of studies, this treats small linear contractures; wide diffuse ones are more complex and require a different approach, such as local tissues.
- Skin grafting
- After the scar is cut, a defect remains and it is covered with a graft — preferably full-thickness. The skin is taken from another area of the body.
- Local and perforator flaps
- A flap is skin with subcutaneous tissue and its own blood supply. In a randomized study (16 flaps and 14 full-thickness grafts), after 12 months, the area of flaps averaged 142% of the initial size, while grafts averaged 92%. The authors recommend preferring such flaps when possible; the study is small.
- Free flaps
- Tissues are transplanted from another area by stitching the vessels under a microscope. Due to the complexity and risks, they are often considered a last resort. According to a meta-analysis of 1,026 free flaps in 928 patients, complete flap loss was 3.8%, partial loss 5.95%, and recurrent contracture 0.62%.
- Dermal matrices
- Artificial dermis under a thin skin graft. In a randomized study of 39 patients, three different matrices did not reduce late graft contraction, so the authors recommend carefully selecting them for this purpose.
02
Recurrent contracture
- Why it returns
- In a study of 30 axillary contractures in 27 adults, recurrent contracture occurred in 30%. After Z-plasty — in 16.7%, after skin grafting alone — in 60%; the groups were small, so this is a guideline, not a rule.
- What is done about this
- In the same study, 7 out of 9 recurrent contractures (77.8%) were operated on again.
03
Splints and movement
- Splints and orthoses
- A practical guideline for adults after burns recommends considering splints to increase range of motion or reduce contractures. There is no convincing evidence from research reviews that splints prevent contracture.
- Therapeutic physical exercise
- Rehabilitation sessions after surgery are part of the treatment plan; the program is tailored to the joint and the surgery.
04
The scar itself
- Laser
- An international group of 26 dermatologists and plastic surgeons from 13 countries has named the laser as a first-line method for traumatic scars and contractures. According to a meta-analysis, fractional CO2 laser significantly improved burn scars, and reports of side effects were very few.
- Own fat
- Lipofilling — transplantation of one's own fat — according to a meta-analysis of 9 randomized studies, reduced scars, especially when combined with other methods; the authors warn that larger studies are needed for solid conclusions.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Post-burn contractures at the Valikhnovskyi Surgery Institute are treated in the direction of 'Reconstruction after Burns': first restoring movement and function, then working on appearance. Contractures of the hand and foot are restored together with the 'Hand and Foot Recovery' direction. A fresh burn is treated in the emergency department or burn unit.
CLINIC SERVICE
Reconstruction after burns
Scars, contractures, and lost tissue after burns — first movement and function, then appearance.
View service
What we do for this condition
- Incision and excision of the cord — scar bands are cut or excised to free the joint.
- Z-plasty and local flaps — for scar bands across a joint: armpit, elbow, fingers, knee.
- Skin grafting — split-thickness or full-thickness graft when there is not enough skin.
- Perforator and free flaps, dermal matrices — for large defects and deep structures; dermal matrices — as indicated: in a randomized study they did not reduce late graft contraction.
- After surgery — splints, compression garments, physical therapy; laser and lipofilling for the scar itself.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of the scar in motion — arm raised, joint extended — and the discharge summaries: the doctor will preliminarily assess the situation.
- ConsultationExamination of scars, measurement of movement, discussion of what hinders the most.
- PlanWhich to release first, which method to use to cover the lack of skin, how many stages approximately.
- SurgeryJoint release and defect closure; several contractures are sometimes operated in stages.
- RecoverySplint, dressings, compression garments, and sessions with a rehabilitation specialist to prevent contracture from returning.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How long after a burn can a contracture be operated on?
The scar changes gradually: according to the NHS, most scars fade over time, and this can take up to 2 years or more. However, if the contracture interferes with movement, surgery is sometimes done earlier. The timing is determined by the surgeon after examination.
I’ve had a burn for many years. Is it not too late?
Usually not. In a meta-analysis of free flaps, reconstruction was performed on average 94.7 months (almost 8 years) after the burn. An old contracture can be operated on if the overall condition allows.
Can the contracture return after surgery?
It can. In a study of axillary contractures, recurrence was 30%. Splints and physiotherapy after surgery are part of the treatment.
Is it possible to do without surgery?
According to the meta-analysis, fractional CO2 laser significantly improved burn scars, and splints, according to the guideline, are considered to increase movement. If there is not enough skin to extend the joint, the deficiency is surgically covered — with a flap or graft.
Where is the skin for transplantation taken from?
From the patient's own body — for example, from the thigh, buttock, or abdomen. The donor site heals but also leaves a mark.
Are contractures treated in children?
Yes. In a study of 1031 children with major burns, 23% had at least one contracture at the time of discharge. The authors note that as the child grows, contractures may increase, so scars are regularly monitored. If a scar interferes with growth, surgery is performed earlier, without waiting for it to mature.
A sore has appeared on an old scar that does not heal. Is this dangerous?
Such an area should be shown to a doctor. According to a systematic review of 1016 patients, cancer in chronic wounds and scars is rare; among people with such cancer, 68% developed it at the site of a burn. If a wound does not heal for more than 4 weeks — do not delay a check-up.
Sources
20 sources · guidelines, consensuses, systematic reviews, randomized studies, and NHSshowCollapse
- Prevention and Treatment of Burn Scar Contracture: A Practical ReviewPlastic and Reconstructive Surgery – Global Open, 2024doi:10.1097/GOX.0000000000005333 ↗
- Prevalence of scar contractures after burn: A systematic reviewBurns, 2017doi:10.1016/j.burns.2016.08.002 ↗
- A systematic review on burn scar contracture treatment: searching for evidenceJournal of Burn Care & Research, 2015doi:10.1097/BCR.0000000000000106 ↗
- Perforator-based flaps for the treatment of burn scar contractures: a reviewBurns & Trauma, 2017doi:10.1186/s41038-017-0071-2 ↗
- Perforator-Based Interposition Flaps Perform Better Than Full-Thickness Grafts for the Release of Burn Scar Contractures: A Multicenter Randomized Controlled TrialPlastic and Reconstructive Surgery, 2017doi:10.1097/PRS.0000000000002993 ↗
- Free Flap Failure and Contracture Recurrence in Delayed Burn Reconstruction: A Systematic Review and Meta-analysisPlastic and Reconstructive Surgery – Global Open, 2024doi:10.1097/GOX.0000000000006026 ↗
- Evaluation of contraction of the split-thickness skin graft using three dermal matrices in the treatment of burn contractures: A randomised clinical trialWound Repair and Regeneration, 2022doi:10.1111/wrr.13002 ↗
- Pediatric Contractures in Burn Injury: A Burn Model System National Database StudyJournal of Burn Care & Research, 2017doi:10.1097/BCR.0000000000000341 ↗
- Scar Contracture Recurrence After Axillary Burn Reconstruction in Adults: A Single Institution’s 14-Year ExperienceJournal of Burn Care & Research, 2026doi:10.1093/jbcr/iraf176 ↗
- Systematic Review and Expert Consensus on the Use of Orthoses (Splints and Casts) with Adults and Children after Burn Injury to Determine Practice GuidelinesJournal of Burn Care & Research, 2020doi:10.1093/jbcr/irz150 ↗
- A review on static splinting therapy to prevent burn scar contracture: do clinical and experimental data warrant its clinical application?Burns, 2012doi:10.1016/j.burns.2011.06.003 ↗
- Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus RecommendationsLasers in Surgery and Medicine, 2020doi:10.1002/lsm.23201 ↗
- Fractional CO2 laser treatment for burn scar improvement: A systematic review and meta-analysisBurns, 2021doi:10.1016/j.burns.2020.10.026 ↗
- Effectiveness of fat grafting in scar reduction: A systematic review and meta-analysisJournal of Cosmetic Dermatology, 2022doi:10.1111/jocd.15067 ↗
- Current Trends in Management of Marjolin’s Ulcer: A Systematic ReviewJournal of Burn Care & Research, 2021doi:10.1093/jbcr/iraa128 ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- Burns and scaldsNHS, 2026nhs.uk/conditions/burns-and-scalds ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
- Symptoms of non-melanoma skin cancerNHS, 2026nhs.uk/conditions/non-melanoma-skin-cancer/symptoms ↗
The figures on the page are from these sources.
Scar does not allow
movement?
Send a photo of the scar in motion and discharge summaries. The doctor will advise how to release the joint and what is needed for it.