Generally speaking, the operation time should not be too early, and should be carried out after the scar is stable and has entered a mature stage and the basement is loose. Premature operation often leads to unclear normal anatomical level due to scar adhesion, which is prone to accidental injury and more bleeding. However, if it is around the eyelids or mouth, in order to protect vision or solve the difficulty of eating, it is necessary to operate as soon as possible. At present, in the repair and treatment of late burn, early operation is advocated for scar contracture of functional parts to avoid secondary deformity, especially in childhood. While waiting for the opportunity of operation, if it is a contracture scar at the joints of limbs, the wounded should be instructed to actively carry out functional exercise.
Complete release of contracture is the key step of surgical treatment. Limbs should be performed under inflatable tourniquet, which can reduce bleeding, make the operation field clear and speed up the operation progress. After the incision perpendicular to the longitudinal axis of contracture was released, the scar and normal tissue were gradually peeled off. In this process, the assistant supports the contracture to keep it tense for surgery, and the wound keeps expanding until the contracture is completely relieved. He asked that in the limbs, sometimes auxiliary operations such as tendon lengthening, joint capsule incision and joint ligament resection are needed to achieve complete release. It is convenient to apply appropriate external force when loosening, but it is forbidden to use violent traction to force joint reduction to avoid tearing nerves, blood vessels and other soft tissues. If it is really impossible to reduce, postoperative traction or joint formation or fusion can be carried out according to the situation. If it is unstable after reduction, the facet joint can be put into Kirschner wire for short-term braking for 2~3 weeks. Larger joints must be fixed with plaster bandage after operation. The principle of scar excision should be total excision, but if the area is too large or the donor site is limited, most scars can be removed on the premise of fully relieving contracture. The edge of the wound on both sides of the joint, if not in the lateral midline, must be cut into sawtooth shape.
Except for a few webbed contracture scars, Z-plasty can only be used occasionally to repair wounds, and in most cases, skin needs to be supplemented. Generally, medium-thick skin graft is feasible. If the skin graft area is large and the weight of skin source is insufficient, superficial atrophic scar can be selected as the donor site. If the wound defect is deep after scar resection, and complicated operation of tendon, nerve or joint is needed at the same time or later stage, skin flap or skin tube should be used for repair. This situation should be fully estimated before operation. If we plan to postpone the transfer of skin flap or skin tube operation, we should accurately predict the size and shape of the wound after contracture release according to some body surface signs and after repeated measurement and comparison on both sides in front of the wood, so as to avoid mistakes and be caught off guard and difficult to remedy.