Burn sequelae: restoring function and improving the scar

What are burn sequelae?

When a deep burn heals, it does so with fibrous tissue that lacks the original skin’s elasticity. That is where the typical sequelae come from: the contracture (a scar band or plaque that shortens and "pulls," limiting the movement of joints, neck, eyelids or mouth corners), the hypertrophic scar (raised, red, firm, sometimes itchy or painful), pigment changes, and unstable areas that ulcerate with friction.

Not every sequela needs surgery — some improve with pressure therapy, silicone and time. But when a scar limits function or has stabilized into a result that affects daily life, surgical treatment is clearly indicated.

When to operate on a sequela — and when to wait?

Timing matters as much as technique. As a general rule, a burn scar takes 12 to 18 months to mature: it goes from red, firm and active to pale, flat and stable. Operating on a still-immature scar tends to give worse results, so elective sequelae surgery usually waits for maturation.

The exception is functional: a contracture that significantly limits movement — a neck that will not extend, an eyelid that will not close, a hand losing grip — can be operated without waiting for full maturation, because every month of retraction worsens joint stiffness. That function-versus-time weighing is the heart of the consultation.

How is burn sequelae surgery performed?

There is no single operation but a repertoire, combined according to the sequela:

• Contracture release (with Z-plasties and local plasties): the scar band is divided or geometrically rearranged to give the area back length and movement.
• Excision of the scar plaque and coverage with skin grafts or flaps when the resulting defect cannot be closed directly.
• Staged surgery or tissue expansion: in extensive scarring, neighboring healthy skin is leveraged in stages.
• Complementary scar management: silicone, pressure and injections when there is a hypertrophic component — the same arsenal described on the scars & keloids page.
• Fractional laser on mature scars in selected cases, as a complement for texture and flexibility.

Function first, aesthetics second

In burn sequelae the order of goals is explicit. First what limits: extending the neck, closing the eyelid, opening the mouth corner, releasing the armpit or fingers. Then, often in later stages, appearance: texture, color, relief.

It should be said plainly: surgery improves sequelae; it does not return the skin to its pre-burn state. The realistic goal is a functional, stable and significantly better area — not an invisible one. Results may vary according to each patient and the original burn’s depth.

Possible risks and complications

Those of reconstructive surgery — bleeding, infection, partial graft loss, flap compromise — plus those specific to burn scars: partial recurrence of the contracture (especially in growing children and highly mobile joints), hypertrophy of the new scars, and pigment changes. Several sequelae require more than one operative stage, and that is stated in the initial plan, not halfway through.

All surgery carries risk and requires a prior medical assessment. Results may vary according to each patient, their anatomy and their individual healing process.

Who is a good candidate?

Patients with stable burn sequelae that limit function or significantly affect their life: joint or neck contractures, extensive hypertrophic scarring, unstable areas that ulcerate, eyelid or lip retractions. At the consultation each area is examined, what is surgical is separated from what is managed with scar treatment, and a staged plan with clear priorities is proposed.

Before and after

Most patients want to see before-and-after photographs before deciding. Out of respect for each person’s privacy, Dr. Arístides Arellano shows real cases —always with documented consent— during your in-person consultation, where you can review results from patients with a starting point similar to yours. Results may vary from patient to patient.

Approximate price in Puebla

Every sequelae plan differs in number of stages, techniques and surgical setting, so the quote is defined at the consultation, in writing and per stage. You can also see the practice’s reference price list for other procedures. Approximate price — the definitive cost is set at your private consultation with Dr. Arístides Arellano.

Credentials

Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.

Documented training in burns and rehabilitation

A burn sequela is not a scar: it is a lost function — a neck that will not turn, a hand that will not open. Dr. Arístides Arellano is a specialist in Plastic & Reconstructive Surgery authorised by the DGP since 1990, and his burns training is documented in both Mexico and Argentina:

• Certificate — Mexican Burn Association — BUAP y Asociación Mexicana de Quemaduras, A.C. · 1992
• Symposium: cutaneous substance loss — Instituto Marcelo J. Fitte · Buenos Aires
• Symposium on rehabilitation — Instituto Marcelo J. Fitte · Buenos Aires
• Update course: tissue expanders — XXVI Congresso Brasileiro de Cirurgia Plástica · Blumenau, 1989

Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.

Recovery · step by step

• Days 1–7Immobilization or splinting of the released area when applicable; wound care according to the coverage used.
• Weeks 2–4Progressive suture removal; rehabilitation or prescribed movement exercises begin to maintain the length gained.
• Months 1–3Key phase: night splints, pressure or silicone per the plan, and consistent exercise — contracture is fought with daily discipline.
• Months 3–12Maturation of the new scars; follow-up to detect and treat any re-retraction early.
• Later stagesIf the plan is staged, intervals between surgeries are set according to each area’s progress.

Frequently asked questions

Every figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.

Educational content; it does not replace a medical consultation. Results may vary from person to person.