As scarring?

As scarring.  Photo from

Unfortunately, skin scars are the inevitable consequence of any open injury or surgery. They remain for a lifetime, often creating a significant cosmetic and functional defects. Disfiguring scars, scars that limit even small movements can cause serious problems in patients, both in business and in personal life. People, by chance, faced with this problem, you should know that the quality of most scars can be improved to some extent.

The mechanism of formation of scars

Wound healing — is a complex biological process, which lasts about a year and completes the formation of a mature scar. One year later, the scar tissue will continue to change, but very slowly and unobtrusively.

In physiological terms, there are several parts of the formation of scar: tissue damage -> damaged cells secrete biologically active substances -> biologically active substances trigger an inflammatory response and attracted to the place of injured cells that produce collagen (Fibroblasts) -> begins the synthesis of new collagen -> produced "young" tripe (red, swollen, towering above the skin) -> 3 weeks after the injury dissipate excess collagen is formed normal scar (pale, flat). If we consider the normal scar tissue under a microscope, it is seen as orderly arranged collagen fibers — they are stacked compact and elongated parallel to the surface of the skin.

In some cases, the normal scarring process is broken. The reasons for this are numerous: burn, festering wounds, the lack of an adequate comparison gaping edges, high tension surrounding the wound of the skin, especially the immune system, genetic predisposition, etc.

Report as typically occurs in step synthesis and collagen resorption of surplus. Instead of the usual flat or concave shaped scar protruding from the skin scar, and in rarer cases — keloid rumen.

From a practical point of view it is important to follow the anatomical, visible changes in tissue healing. For the doctor and the patient are two relevant characteristics of the scar — the strength and appearance. The developed clinical and morphological classification stages healing allows to monitor the healing stage and select appropriate types of scar correction.

Stage of healing

Stage I— Inflammation and epithelialization (7-10 day after the injury). Posttraumatic skin inflammation decreases gradually. Wound edges are connected with each other fragile granulation tissue, such as scar yet. This period is very important for the formation of the future of thin and flexible scar — it is important to prevent abscesses and wound dehiscence. For these purposes, cosmetic surgeons impose fixing seams special atraumatic suture material (very thin filaments with a circular cross-section) and prescribe topical anti-inflammatories for daily dressings. Recommended restriction of physical activity, as the frequent movement of the muscles, tendons and ligaments can cause a wound dehiscence.

Stage II— The formation of the "young" tripe (10-30 day after the injury). In the granulation tissue begin to form collagen and elastin fibers. Increased blood flow to the area preserved injury — scar bright pink color. While fiber is not ripe, rumen is easily extensible, so in this period should not be allowed to re-traumatization and external undue force.

Stage III— The formation of the "mature" scar (30-90 day after the injury). The number of fibers of collagen and elastin is significantly increased, the fibers begin to line up in a certain direction beams. The number of vessels is reduced — the scar is compacted and becomes pale. Permission is granted to physical activity in the usual volume. At this stage, unfavorable conditions (see above) leads to the formation of hypertrophic and keloid scars.

Stage IV— The final transformation of the scar (4-12 month after injury). Scar tissue slowly ripen — are completely disappear vessels, collagen fibers are aligned along the lines of greatest tension. The scar will become bright and dense. At the beginning of this period, the surgeon can finally assess the condition of the skin scar and determine the type of surgical correction.

Types of scars

  • Normotroficheskie — are the result of normal connective tissue response to injury. This is a light-colored flat scars with normal or reduced sensitivity and close to normal tissues elasticity. These scars are optimal.
  • Atrophic scars — result from a reduced response of connective tissue to injury. Collagen is produced is not enough. Atrophic scars are below the level of the surrounding skin (sink). When a small width do not differ from normotroficheskih.
  • Hypertrophic scars are the result of excess connective tissue response to injury against the adverse conditions of healing (inflammation, scar stretching). Fibroblasts with increased activity of an excess amount of collagen is synthesized, it does not dissipate the excess to the fullest. Externally hypertrophic rumen are protruding above the skin surface lightly compacted strand (in the form of rope), the width of which may vary. Dimensions correspond to the preceding injury scar the skin. Hypertrophic scars are able to smooth out through 1-15 years after injury, but not always completely.
  • Keloids develop as a consequence of distorted tissue response to injury. Usually, keloids are formed on the background of reduced levels of total and tissue immunity. Keloids are an elastic consistency, uneven, slightly wrinkled surface, significantly above the surface of the skin. Sometimes the kind remind warts. Keloids are constantly growing — then fast, then slow, their growth can be accompanied by itching, burning and pain. As a result of the ongoing increase of the volume of the visible part of the scar can be several times higher than the volume of its intradermal part. Keloids are not capable of spontaneous regression. A typical example is the keloid scars formed after piercing the earlobe to wear jewelry.

Source: Medical center "Paracelsus 2001"

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