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

Figure 5.2
Keloid scar example.
Pathophysiological Scar Formation – What can go Wrong
Multiple factors can contribute to impaired wound healing. To generalize, these
factors can be categorized as local and systemic:
• Local: directly influence the characteristics of the wound itself, for example
oxygenation, infection and the various aspects of the inflammatory cascade.
• Systemic: encompass the individual general state of health – in particular,
factors which may affect his or her ability to heal. Some systemic factors
include: genetic predisposition, age, stress levels, existing pathologies, neuroinflammatory
and neurogenic issues (covered in greater detail in Chapter 4),
medications, nutritional and lifestyle practices (e.g. sedentary tendencies,
smoking and exposure to other pollutants). Research shows that smoking
(nicotine) has a detrimental impact on all stages of wound healing resulting in
delayed healing and a higher incidence of scar complications. Smoking
cessation reverses some but not all of the mechanisms involved as many of the
pathologic processes induced by smoking appear to be prolonged or even
irreversible despite abstinence from smoking (Avery & Bailey 2008, Sorenson
2012).
Essentially the primary presentation seen with pathological scars is excessive
collagen proliferation. Normally, the body stops collagen production when
adequate strength of the scar is obtained. When collagen production does not
shut down, pathological scars will form (Box 5.1).
Scar
type/term
Cicatric
Contracture
Description and other important information
Generalized term used to describe a scar left by the formation of new connective tissue over a
healing sore or wound. This type of scar may have considerable contraction. It may be necessary to
divide the scar and then graft on new skin, as is done for burns
Common post-burn injury crossing joints or skin creases at right angles. Contractures are often
disabling or result in dysfunction as they prevent or limit normal mobility. Contracture occurs
before the scar fully matures and often presents as hypertrophic