Vita TU, Occupational Therapist and Project Manager
Sunshine Social Welfare Foundation
Addressing burn hypertrophic scars on the back of fingers presents significant challenges for burn therapists. The extensibility of the skin, a critical factor in joint movement, is compromised by the excessive collagen proliferation and centripetal contraction characteristic of hypertrophic scars.
Research by Reginald L. and others in 1994 and 2009 revealed that during joint activity, the surrounding skin stretches as the joint moves, but the range of skin recruited extends beyond the immediate vicinity of the joint. Indeed, skin is also recruited from much more distant areas. For example, shoulder joint movement also involves the recruitment of abdominal skin, while wrist movement also recruits skin on the upper arm.
This video highlights the implications of hypertrophic scar growth on finger joints, showcasing how the scar's tightness manifests during movement. These scars limit joint mobility and induce a distinctive blanching, signifying insufficient extensibility. The associated challenges, ranging from altered nail bed shapes to pain during DIP joint flexion, underscore the importance of scar treatment strategies that prioritize enhancing scar flexibility and extensibility for optimal rehabilitation.
References:
Richard R, Ford J, Miller SF, Staley M. Photographic measurement of volar forearm skin movement with wrist extension: the influence of elbow position. J Burn Care Rehabil. 1994 Jan-Feb;15(1):58-61. doi: 10.1097/00004630-199401000-00011. PMID: 8150844.
Richard RL, Lester ME, Miller SF, Bailey JK, Hedman TL, Dewey WS, Greer M, Renz EM, Wolf SE, Blackbourne LH. Identification of cutaneous functional units related to burn scar contracture development. J Burn Care Res. 2009 Jul-Aug;30(4):625-31. doi: 10.1097/BCR.0b013e3181ac016c. PMID: 19506493.