The importance of biomechanics and the kinetic chains of human movement in the development and treatment of burn scars

Dr Andrea Issler-Fisher1,2,3, Prof Peter  Maitz1,2,3

1Burns Unit, Concord Repatriation General Hospital, , Australia, 2Concord Clinical School, University of Sydney, Sydney, Australia, 3ANZAC Research Institute, Concord Repatriation General Hospital , Sydney, Australia


Background: Burn scars are a major clinical sequelae of severe burn wound healing. In order to effectively establish a successful treatment plan and achieve durable results, understanding the pathophysiology of scar development is of utmost importance.
Methods: The principles of the kinematic chain of movement are reviewed and the hypothesised effect on burn scar development is discussed based on observed properties of burn scars. The utility of ablative fractional resurfacing combined with the surgical release of contractures developing in and affecting functional kinematic chains was assessed.
Results: Illustrative cases are presented supporting the underlying hypothesis and demonstrating how to address the principles of functional kinematics when tailoring a reconstructive approach to an individual burn patient. Ablative fractional resurfacing combined with local tissue re-arrangements is a promising approach to address the underlying forces leading to hypertrophic burn scarring.
Conclusion: The presented cases illustrate the importance of recognising and including the principles of functional kinematic chains in any reconstructive treatment approach for burn scars. To achieve an optimal outcome, it is essential to recognise and address the origin of the pathology when treating burn scars.


Dr. Andrea Issler-Fisher has over 10 years of surgical experience with a main focus on Burns & Reconstructive surgery. She is passionate about scar reconstruction and has been the clinical lead of the Burns Scar Clinic at CRGH since 2015. Andrea is interested in novel scar modulation techniques, including ablative fractional CO2 laser. She is a Clinical Senior Lecturer University of Sydney, and recently submitted her PhD-thesis on: “Ablative Fractional Resurfacing for Burn Scars & the Impact on Reconstructive Burn Surgery: Exploring the Effects of a Novel Treatment Paradigm”.

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