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

formation – granulation tissue. This forms a structural framework to bridge the wound and allow
vascular ingrowth in the form of fresh capillary beds. The wound gap begins to decrease as MFBs
contract and physically draw the severed tissue fragments together. Eventually, collagenase is
released to degrade the fine Type III collagen that helped form the provisional matrix as a stronger
matrix replaces the provisional one to better support day-to-day function. Fibroblasts synthesize
GAGs and Type I collagen and continued Type 1 collagen proliferation ensures the scar tissue
becomes stronger. In some cases edema, elevated temperature around the wound and pain may still
be present. This stage typically lasts 4–21 days but may last for up to 6 weeks
4:
Remodeling
Regression of capillary hypervascularity commences prompting a return to normal vascular
density. The wound continues to undergo MFB-mediated contraction, ensuring the formation of a
mechanically sound scar. Adequate amounts of TGF-β1 and mechanical tension assure the
restoration of normal/physiological ECM and tissue architecture. Normal scar tissue progresses
from being red and prominent, to becoming thin and pale. As long as the scar appears redder than
normal, remodeling is still under way. Normally, this stage should be relatively painless and yield
an innocuous scar that exhibits normal coloration, is relevant in size and is mobile. There should be
no significant degree of pain associated with a properly healing wound nor any residual pain
experienced, once remodeling has completed. The remodeling stage can last from months to years