Scars Heal, But How?
When we are small, we usually have to endure many different types of injuries such as burns, cuts, and knocks or bangs in our body. These injuries become less during adulthood, but we still sustain them well. How is it possible? Well, all of these aggressions start an orderly set of events that are involved in the healing response, in which the normal healthy tissue (skin) is replaced by connective tissue (scar). The healing response is also characterized by the migration of specialized cells into the injury site.
Healing is the complex and dynamic process that results in the restoration of anatomical continuity and function. There are 4 basic responses that can result after an injury:
1.Regeneration (exact replacement)
Skin regeneration occurs when there is loss of structure and function. Our body is so incredible, that it has the complex ability to replace that tissue by replacing exactly what was there before the damage. Lower forms of life, such as the salamander and crab, can regenerate tissue in this manner. As man has evolved, we have lost this ability and can only replace a limited amount of injured tissues by the process of regeneration.
2. Normal repair (reestablished equilibrium)
Normal repair is the response where there is a re-established equilibrium between scar creation and scar remodeling. This is the typical response that most humans develop after an injury. The abnormal response to tissue damage stand in sharp contrast to the healthy repair response.
3. Excessive healing (fibrosis and contractures)
In excessive healing there is an exaggerated accumulation of connective tissue; this produces an altered tissue and, thus, loss of function. Fibrosis, structures, adhesions and contractures are examples of exaggerated healing. Keloids and hypertrophic scars in the skin are examples of fibrosis. Contraction is part of the normal process of healing but if exaggerated, it becomes pathologic and is called a contracture.
4. Deficient healing (chronic ulcers)
Deficient healing is the opposite of fibrosis; it appears when there is insufficient deposition of connective tissue matrix and the tissue is thinned to the point where it can fall apart. Persistent non-healing ulcers are examples of deficient healing.
The Skin’s Natural Healing Process
Just as an injury occurs, several different cells are sent to the damaged site, and the complex healing process begins.
The normal healing cascade begins with an coordinated process of hemostasis and fibrin accumulation, which initiates an inflammatory cell cascade, characterized by neutrophils, macrophages and lymphocytes within the damaged tissues. This is followed by migration and proliferation of fibroblasts and collagen accumulation, and finally remodeling by collagen cross-linking and scar maturation. Despite this coordinated sequence of events responsible for normal wound repairing, abnormal responses leading to fibrosis or chronic ulcers may occur if any part of the healing sequence is altered.
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