A review on static splinting therapy to prevent burn scar contracture: Do clinical and experimental data warrant its clinical application?

Abstract 

Background

Static splinting therapy is widely considered an essential part in burn rehabilitation to prevent scar contractures in the early phase of wound healing. However, scar contractures are still a common complication. In this article we review the information concerning the incidence of scar contracture, the effectiveness of static splinting therapy in preventing scar contractures, and specifically focus on the – possible – working mechanism of static-splinting, i.e. mechanical load, at the cellular and molecular level of the healing burn wound.

Method

A literature search was done including Pubmed, Cochrane library, CINAHL and PEDRO.

Results

Incidence of scar contracture in patients with burns varied from 5% to 40%. No strong evidence for the effectiveness of static splinting therapy in preventing scar contracture was found, whereas in vitro and animal studies demonstrated that mechanical tension will stimulate the myofibroblast activity, resulting in the synthesis of new extracellular matrix and the maintenance of their contractile activity.

Conclusion

The effect of mechanical tension on the wound healing process suggests that static splinting therapy may counteract its own purpose. This review stresses the need for randomised controlled clinical trials to establish if static splinting to prevent contractures is a well-considered intervention or just wishful thinking.

Keywords: Burns, Rehabilitation, Splinting, Stretching, Stress, Strain, Mechanical load, Wound healing, Scar, (Myo)fibroblast, Collagen, Contraction