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

Wound Healing
The NS plays an important role in mediating normal wound healing via the
involvement of various neuropeptides and growth factors. Noxious stimuli
causes nerves to release neuropeptides such as substance P and CGRP and
certain growth factors (e.g. NGF). And, along with healthy scar formation, in
order to re-establish normal functioning post-injury, innervation of the injured
tissue must also be re-established.
Wounds initially display hyperinnervation, similar to hypervascularization seen
in early wound healing. With normal wound healing, nerve density will
normalize with scar maturation. Although densities may return to normal,
normal responsiveness is not always re-established, as nerve end organs cannot
regenerate and therefore sensory deficit or aberrancies may occur. In spite of the
clinical significance of abnormal innervation in scars, the NS has been largely
ignored in the pathophysiology of scars.
The role of the NS in wound healing, normal and abnormal, is covered in greater
detail in Chapter 5.
Impact of Trauma and Pathophysiological Scars on
the NS
As nerves traverse throughout the body they track between and pass through
various tissues and structures. The greater proportion of our larger nerves track
in the superficial fascia and smaller nerves in the clefts created between
perimysial bundles.
Irritation or compression at any point along the complex network of the NS can
evoke changes not only locally but also in distant regions and can elicit
autonomic disturbances.
Excessive scarring in the layers of tissue a nerve is travelling through can
impede all manner of NS functioning (e.g. nerve and electromagnetic
conduction, local and systemic responsiveness, sensitization, intraneural blood
and nerve supply).
Additionally, injured or distressed somatic tissues adjacent to nerve structures