Burn scar contracture

Burn scar contracture is the tightening of the skin after a second or third degree burn. When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area. This is mediated by myofibroblasts.


Burn scar contractures do not go away on their own, although may improve with the passage of time, with occupational therapy and physiotherapy, and with splinting. If persistent the person may need the contracture to be surgically released. Techniques may include local skin flaps (z-plasty) or skin grafting (full thickness or split thickness). There are also pharmacy and drug-store treatments that can be used to help scar maturation, especially silicone gel treatments. Prevention of contracture formation is key. For instance, in the case of a burned hand one would splint the hand and wrap each finger individually. In the instance of burns on the neck, hyperextension of the neck (i.e. no use of pillows) should be maintained during the healing process. Carbon dioxide laser therapy is now also used to aid in the loosening of surrounding skin, although is yet to form as part of an official global rehabilitation program.

Atomic bombings of Hiroshima and Nagasaki

During the final stage of World War II, the United States detonated two nuclear weapons over the Japanese cities of Hiroshima and Nagasaki on August 6 and 9, 1945, respectively. The United States dropped the bombs after obtaining the consent of the United Kingdom, as required by the Quebec Agreement. The two bombings killed 129,000–226,000 people, most of whom were civilians. They remain the only use of nuclear weapons in the history of armed conflict.

In the final year of the war, the Allies prepared for what was anticipated to be a very costly invasion of the Japanese mainland. This undertaking was preceded by a conventional and firebombing campaign that destroyed 67 Japanese cities. The war in Europe had concluded when Germany signed its instrument of surrender on May 8, 1945. As the Allies turned their full attention to the Pacific War, the Japanese faced the same fate. The Allies called for the unconditional surrender of the Imperial Japanese armed forces in the Potsdam Declaration on July 26, 1945—the alternative being "prompt and utter destruction". The Japanese rejected the ultimatum and the war continued.

By August 1945, the Allies' Manhattan Project had produced two types of atomic bombs, and the 509th Composite Group of the United States Army Air Forces (USAAF) was equipped with the specialized Silverplate version of the Boeing B-29 Superfortress that could deliver them from Tinian in the Mariana Islands. Orders for atomic bombs to be used on four Japanese cities were issued on July 25. On August 6, one of the modified B-29s dropped a uranium gun-type bomb codenamed "Little Boy" on Hiroshima. Three days later, on August 9, a plutonium implosion-type bomb codenamed "Fat Man" was dropped by another B-29 on Nagasaki. The bombs immediately devastated their targets. Over the next two to four months, the acute effects of the atomic bombings killed 90,000–146,000 people in Hiroshima and 39,000–80,000 people in Nagasaki; roughly half of the deaths in each city occurred on the first day. Large numbers of people continued to die from the effects of burns, radiation sickness, and other injuries, compounded by illness and malnutrition, for many months afterward. In both cities, most of the dead were civilians, although Hiroshima had a sizable military garrison.

Japan announced its surrender to the Allies on August 15, six days after the bombing of Nagasaki and the Soviet Union's declaration of war. On September 2, the Japanese government signed the instrument of surrender, effectively ending World War II. The effects of the bombings on the social and political character of subsequent world history and popular culture has been studied extensively, and the ethical and legal justification for the bombings is still debated to this day.


This article refers to permanent shortening of muscles, tendons, or ligaments. For short-term contraction of muscles, see Muscle contraction.

A muscle contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like spastic cerebral palsy.

Contractures are essentially muscles or tendons that have remained too tight for too long, thus becoming shorter. They develop when these normally elastic tissues are replaced by inelastic tissues. This results in the shortening and hardening of these tissues, ultimately causing rigidity, joint deformities, and a total loss of movement around the joint. Most of the physical therapy, occupational therapy, and other exercise regimens targeted towards people with spasticity focuses on trying to prevent contractures from happening in the first place. However, research on sustained traction of connective tissue in approaches such as adaptive yoga has demonstrated that contracture can be reduced, at the same time that tendency toward spasticity is addressed.

Contractures can also be due to ischemia, as in Volkmann's contracture.

Excessive matrix metalloproteinase and myofibroblast accumulation in the wound margins can result in contracture.

Wound contracture

Wound contracture is a process that may occur during wound healing when an excess of wound contraction, a normal healing process, leads to physical deformity characterized by skin constriction and functional limitations. Wound contractures may be seen after serious burns and may occur on the palms, the soles, and the anterior thorax. For example, scars that prevent joints from extending or scars that cause an ectropion are considered wound contractures.


Z-plasty is a versatile plastic surgery technique that is used to improve the functional and cosmetic appearance of scars. It can elongate a contracted scar or rotate the scar tension line. The middle line of the Z-shaped incision (the central element) is made along the line of greatest tension or contraction, and triangular flaps are raised on opposite sides of the two ends and then transposed. The length and angle of each flap are usually the same to avoid mismatched flaps that may be difficult to close. Some possible complications of Z-plasty include flap necrosis, haematoma (blood clot) formation under the flaps, wound infection, trapdoor effect and sloughing (necrosis) of the flap caused by wound tension and inadequate blood supply.

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