What does the procedure treat?
A scar that has shortened and tightened the skin.
This is called a contracture. It may develop after a burn, injury, or surgery and can interfere with movement or pull nearby features out of position.
Scar, Skin & Wound
Scar Contracture Release with Local Flap
Scar contracture release with a local flap loosens tight scar tissue and moves nearby skin to improve flexibility and coverage.
How is a local flap different from a skin graft?
A local flap moves nearby tissue while keeping a blood supply attached.
A skin graft is completely separated from its original location and must establish a new blood supply where it is placed.
Will the scar disappear?
No. The aim is to reduce restriction, not erase every scar.
Treatment creates a new scar pattern. Appearance may improve, but the scar can remain noticeable and tightness can return.
01 · Overview
Making room for more comfortable movement
A contracture forms when healing tissue tightens enough to restrict movement or distort nearby skin. Releasing it may help, especially when the scar crosses a joint or pulls on a feature such as the eyelid or mouth. [1]
The surgeon releases or rearranges the tight scar and uses nearby tissue to cover the area with less tension. A local flap stays connected to a blood supply. Its shape and movement depend on the scar and the amount of healthy, flexible skin nearby. [2]
This is different from simply removing a visible scar or resurfacing its surface. The focus is on restricted tissue and function, although appearance also matters. A consultation determines whether a local flap can provide enough release or whether another reconstructive approach is needed. [2]
- Primary goal
- Release tightness and improve function
- Tissue used
- Nearby skin with an attached blood supply
- Anesthesia
- Local anesthesia, sedation, or general anesthesia
- Recovery
- Depends on location, flap size, and rehabilitation needs
Does the scar need to mature first?
Some scars soften with time, so timing depends on symptoms and healing. A scar that threatens function may need earlier treatment rather than waiting for full maturation.
Can skin release fix every movement limitation?
No. Tendon, joint, muscle, or nerve problems may also restrict movement. Your surgeon will assess whether the skin is the main cause and whether other treatment is needed.
02 · Concerns & Goals
What a tight scar can change
A scar may feel tight, pull on nearby skin, or limit movement. Your surgeon can help identify what is causing the restriction.
Restricted movement
A tight band of scar may make it harder to bend, straighten, reach, or use the affected area.
Pulling or discomfort
Stretching the scar may cause pulling, tenderness, or friction during everyday activities.
Distorted skin or features
Scar tension can draw surrounding skin out of position or change the shape of a nearby feature.
Visible scarring
You may want a less conspicuous scar while preserving or improving function. Release changes the scar rather than removing all evidence of it.
03 · Options
How the approaches differ
These are possible local-flap approaches, not a menu suitable for every scar. Your surgeon chooses a design based on tissue quality, blood supply, and the direction of tension.
Z-plasty
Rearranges small triangular flaps across a tight scar.
How it worksThe triangles exchange positions to lengthen the contracted line and redirect tension.
May suitSelected narrow scar bands with enough flexible surrounding skin.
Main tradeoffCreates a zigzag scar and may not provide enough release for a broad contracture.
Advancement flap
Slides nearby tissue into the released area.
How it worksAdjacent skin is mobilized and advanced while maintaining its blood supply.
May suitAreas with enough nearby skin that can move in the needed direction.
Main tradeoffMovement is limited by skin laxity, and closure must avoid excessive tension.
Rotation flap
Turns nearby tissue into the opening.
How it worksA curved flap rotates around an attached base to cover the released area.
May suitSelected defects where surrounding skin can move along an arc.
Main tradeoffMay require a longer incision and can change the surrounding contour.
Transposition flap
Moves adjacent tissue across into the release site.
How it worksA flap pivots over intervening tissue while remaining attached to its blood supply.
May suitSelected scars where usable skin lies beside rather than directly behind the defect.
Main tradeoffAdds scars at the tissue-donor area and may create fullness or uneven contour.
Local-flap reconstruction requires healthy tissue and a reliable blood supply. More extensive contractures may need grafting, tissue expansion, or another type of flap. [1] [2].
Is Z-plasty always the best choice?
No. It can help lengthen a narrow scar band, but heavily scarred surrounding skin may not stretch or survive reliably in that design.
Could more than one procedure be needed?
Yes. Broad or longstanding contractures may need staged reconstruction, and later treatment may address remaining restriction or contour concerns.
04 · Results
What may improve and what may remain
Movement and comfort
Release may allow the skin to move more freely.
- The benefit depends on how much restriction comes from the skin rather than deeper structures.
- Therapy or splinting may be part of preserving the improvement.
Scar appearance
Expect a changed scar pattern, not scar-free skin.
- A longer or angled scar may replace a short, tight band.
- Color, firmness, and contour continue changing over months.
Long-term stability
Tightness can recur as tissue heals.
- Growth, ongoing tension, and the original injury can affect durability.
- Some people need additional scar care or further surgery.
Final scar appearance may take a year or longer to settle. Functional recovery and scar maturation follow different timelines. [3]
05 · Recovery
Planning your recovery
Recovery at a glance
- Stay after surgery
- Determined by Your Surgeon
- Initial recovery at home
- Varies by Individual
- Return to desk work
- Varies by Procedure and Work Activity
- Light daily activities
- Based on Individual Recovery
- Strenuous exercise
- Based on Surgeon Clearance
Returning to work does not mean fully healed. Follow your surgeon’s instructions; strenuous activity requires clearance.
Recovery depends on where the flap is placed and how much tissue is released. Your surgical team will balance protecting the flap with restarting movement safely.
Step 1 · Day of surgery
Treatment day
The team checks the flap and applies the planned dressing. You may receive a splint or positioning instructions. Discharge timing depends on the procedure and anesthesia.
Step 2 · First several days
Early protection
Swelling, bruising, and soreness are common. Follow your team's specific wound-care and movement plan, and report unexpected changes in the flap promptly.
Step 3 · Following weeks
Guided movement
Wound checks guide when movement, therapy, and daily tasks can increase. Do not force stretching before your team confirms it is safe.
Step 4 · Months and beyond
Scar maturation
The scar gradually changes in firmness and color. Follow-up may focus on movement, scar care, and signs of recurrent tightening.
Planning everyday activities
ActivityGeneral planning contextWhat affects the plan
Work or schoolPlanning context: Timing varies with the treated area and your duties.What affects it: Desk tasks may resume before lifting or repetitive physical work. Returning does not mean healing is complete.
Exercise and liftingPlanning context: Resume in stages when cleared.What affects it: Strain or friction may pull on the closure and affect flap healing.
Stretching and therapyPlanning context: Use a procedure-specific plan.What affects it: Too much movement too early can stress the wound; prolonged restriction can also worsen stiffness.
Bathing and swimmingPlanning context: Ask when the dressing can get wet and when soaking is safe.What affects it: Wound closure and flap healing determine timing, not a fixed calendar date.
Follow your surgical team's instructions rather than a general recovery schedule. Ask before changing a splint, dressing, or exercise plan.
Before your procedure
- Discuss which movements or daily tasks the scar limits most.
- Share your previous operations, wound problems, and scar treatments.
- Review medicines and supplements; change them only as instructed.
- Discuss nicotine use and the team's plan for reducing healing risks.
- Arrange transportation and help if anesthesia or movement restrictions require it.
- Confirm wound-check appointments and whether therapy or splinting will be needed.
When can I start scar massage or silicone?
Only after your team confirms the wound is sufficiently healed. Timing and technique depend on the flap, incision, and skin condition.
Why might I need a therapist?
A therapist can guide movement, measure progress, and fit a prescribed splint when needed. The surgeon and therapist coordinate to protect healing tissue while limiting stiffness.
06 · Safety
Risks and what your clinician assesses
Some soreness, swelling, bruising, and temporary altered sensation are expected. Symptoms should generally improve; a sudden change or worsening pain deserves prompt attention.
Bleeding or fluid collection
Blood or fluid can collect beneath the tissue and may require drainage or another procedure.
Infection or wound separation
Infection or tension can delay healing or cause the incision to open.
Reduced flap blood supply
Part of the flap can fail to heal or die, sometimes requiring additional surgery.
Recurrent tightness or stiffness
The contracture may return, or movement may remain limited despite release.
Scar, contour, or sensation changes
Raised scars, uneven contour, numbness, sensitivity, or persistent pain can occur.
Anesthesia and general surgical complications
Anesthesia reactions and blood clots are possible; your individual risks depend on your health and the extent of surgery.
Discuss these risks and your individual health history with your surgeon. [4]
What your clinician assesses
- Scar location, depth, and effect on movement
- Nearby skin flexibility and blood supply
- Diabetes, nicotine exposure, and other healing risks
- Deeper tissue restriction and ability to follow rehabilitation
07 · Costs
What makes up the Total Procedure & Care Cost
Compare written estimates for the same planned scope: the release, flap reconstruction, treatment setting, and expected follow-up. More extensive or staged reconstruction may involve separate services.
Surgeon
Surgical care
Evaluation, contracture release, and local-flap reconstruction.
Ask your surgeonAsk whether staged procedures or later revisions would be billed separately.
Facility
Anesthesia and facility
Anesthesia services and use of the operating or procedure room.
Ask your surgeonConfirm the setting, anesthesia plan, and whether separate bills are expected.
Supplies
Supplies and follow-up
Dressings, splints, postoperative visits, and related recovery needs.
Ask your surgeonAsk which supplies, therapy visits, and scar treatments are included.
TRC
Patient Services
Any separately listed coordination or administrative services.
Ask TRCAsk whether these services carry a charge and what that charge includes.
Your written estimate should explain the services included, any separate charges, and payment terms.
08 · Questions
Common questions
Is this cosmetic or reconstructive surgery?
Release intended to restore movement or correct tissue distortion is generally reconstructive in purpose. Appearance goals can be discussed alongside function.
Will insurance cover it?
Coverage depends on your plan, documented symptoms, and authorization requirements. Ask your insurer about coverage and out-of-pocket responsibilities before scheduling.
Can a burn scar be treated this way?
Sometimes. Burn scars may leave too little healthy nearby skin for a local flap, so grafting or another reconstruction may be more suitable.
Can the same scar tighten again?
Yes. Healing, skin tension, and growth can cause renewed restriction. Follow-up and an individualized rehabilitation plan help monitor this risk.
0 consultation questions in your plan
View in My TRC workspaceMy Aesthetic Plan
Prepare for your consultation
Bring these to help your consultation:
- Confirm the functional goal, flap design, and alternatives.
- Get a personalized wound-care, movement, and follow-up plan.
- Review the written estimate and any insurance requirements.
View My Aesthetic Plan
Choices stay in this visit until saving to your account completes. Nothing is sent to a clinician.
Sources
- [1]American Society of Plastic Surgeons: Scar RevisionContractures can restrict movement; scar revision can improve a scar but cannot erase it.
- [2]American Society of Plastic Surgeons: Scar Revision ProcedureScar revision approaches include tissue rearrangement, flap techniques, grafts, tissue expansion, and nonsurgical scar treatments.
- [3]American Society of Plastic Surgeons: Scar Revision ResultsScar revision results develop over time, with final scar maturation potentially taking a year or longer.
- [4]American Society of Plastic Surgeons: Scar Revision SafetySurgical risks include bleeding, infection, poor healing, tissue loss, sensation changes, persistent pain, recurrent problems, anesthesia risks, and urgent cardiopulmonary symptoms.
Photographs are illustrative scenes, not patients, staff, facilities or outcomes. This information does not replace a personal assessment by your treating clinician.