[libribook.com] Traumatic Scar Tissue Management 1st Edition

Wound Healing
As with the blood vascular system, successful tissue repair requires the regrowth
and reconnection of lymphatic structures. In the early stages of wound healing,
the formation of lymphatic vessels in circumferential wounds helps bridge the
margins of a newly forming scar (Bellman & Oden 1958, Oliver & Detmar
2002).
In full-thickness skin wounds angiogenesis in newly formed granulation tissue
largely dominates the delayed and comparatively less pronounced formation of
new lymphatic vessels (lymphangiogenesis) (Paavonen et al. 2000, Oliver &
Detmar 2002).
During tissue repair, lymphatic vessels reconnect with lymphatic vessels – not
with blood vessels – and cultured lymphatic endothelial cells remain separate
from blood vascular endothelial cells during tube formation in vitro (Kriehuber
et al. 2001).
It is known that in adults lymphangiogenesis can occur by outgrowth from preexisting
lymph vessels (Clark & Clark 1932, Paavonen et al. 2000) but it is
unclear if during tissue repair lymphangiogenesis involves progenitor cells, as in
angiogenesis.
Impact of Trauma and Pathophysiological Scars on
the Lymphatic System
Trauma and scars can disrupt the network of lymph capillaries, which can hinder
fluid drainage and negatively affect the healing process.
The development of scar tissue that hinders the flow of lymph can have various
causes:
• Surgical procedures that interrupt normal lymphatic function, such as surgery
for cancer in the breast or groin areas, may prevent lymph flowing naturally
through its system (Zuther 2011)
• Radiation therapy can damage an otherwise healthy lymphatic system by
causing scar tissue to form, subsequently interrupting the normal flow of