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How to treat a contracture with a hypertrophic scar?

Q: My son is 11 years old. Last year on the festive occasion of Diwali, a sparkler exploded and the skin of his right hand from the fingers to two inches below the wrist got burnt. I got dressing done at a nearby hospital under anaesthesia twice. He was subsequently treated with Contractubex, Flutivate Cream, Emolene, Mone and olive oil. At present, he wears a pressure glove and gets a light massage and physiotherapy done. He has now developed fibrosis/hypertrophy and has swelling on his ring and middle finger. His ring finger is not flexible. The doctors say that he needs plastic surgery and skin grafting. What do you say?

A:It seems that your child has got a Contracture with a Hypertrophic oblique scar on the Volar aspect of the hand. The treatment that the child is receiving is right. However, I will emphasise it as follows: 1. Use of Compression garment at all times, for at least one year. 2. Gentle massage with Nivea cream for 10 minutes each, 6 times a day. 3. Gentle stretching exercises with the massage. 4. Active Physio-therapy to the affected hand daily. 5. Ultra Sonic treatment to the scar, if available. 6. Try this out for at least one year. 7. There would be considerable improvement after this period. However, some residual deformity may remain. 8. If so, surgery may be required. The surgery may involve excision of scar and skin grafting. 9. After the surgery, a post operative splint may be necessary for 6 to 12 months.

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