Management of Post-Burn Scars: An Updated Review of Prevention, Treatment, and Functional Reconstruction

Post-burn scarring remains one of the most challenging long-term consequences of thermal injury, with relevant functional, aesthetic, psychosocial, and economic implications. Hypertrophic scars, contractures, pruritus, pain, dyschromia, stiffness, and restricted range of motion may persist for years after wound closure and frequently require prolonged multidisciplinary care. Although surgical reconstruction remains essential for established contractures and severe functional impairment, contemporary management increasingly emphasizes early prevention, individualized conservative therapy, scar modulation, laser-based interventions, rehabilitation, and staged reconstructive planning. This review summarizes current evidence regarding the prevention and treatment of post-burn scars, with emphasis on risk stratification, pressure therapy, silicone-based products, taping, massage, orthoses, rehabilitation, laser therapy, laser-assisted drug delivery, dermal substitutes, graft selection, minimally invasive contracture release, and functional reconstruction. Recent literature supports a multimodal approach guided by scar maturity, symptoms, anatomical location, functional limitation, patient age, skin type, resource availability, and patient-reported outcomes. However, significant heterogeneity persists in study design, outcome measures, treatment protocols, and follow-up duration. Current evidence favors individualized treatment rather than a single universal protocol. Early wound closure, tension reduction, symptom control, structured rehabilitation, and timely escalation to procedural or surgical therapy are central principles. Future research should focus on standardized scar assessment, comparative effectiveness trials, pediatric-specific protocols, cost-effectiveness, and integration of patient-centered outcomes.