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

Pathophysiological Consideration
In his exploration of the tendon sliding system, Guimberteau noted, at the
FRC III 2012, that when – certain – tendons move, the movement is barely
discernible in neighboring tissues if no restrictions are present (e.g.
adhesions, fibrosis). According to Guimberteau, variances in non-injured
tissue and tissue during and after scar formation can be seen
endoscopically. Notably, with irregular or abnormal healing (even though
the surface tissue looks normal) below the surface undifferentiated tissue
can be present for several months (e.g. thick/dense and devoid of loose
sliding tissue). Additionally, the hypervasculization typically seen in the
early stages of normal healing will persist far longer with abnormal or
irregular healing. When reconstructive hardware is used (e.g. screws,
plates, and synthetic joint parts) normal scar formation does not occur.
Generally speaking, the greater the damage, the more extensive the scarring and
the more extensive the abnormal scarring, greater is the potential for functional
loss or abnormal functioning (e.g. dermal scars are less resistant to ultraviolet
radiation, hair follicles do not grow back within scar tissue and extensive cardiac
muscle scarring can lead to heart failure). Altered or abnormal healing increases
the likelihood of excessive scarring (adherences), which in turn can impact the
functioning of various tissues and systems.
Pathological scars in skin and fascia alter not only the structure and functioning
of these tissues but also impacts the individual and their body’s capacity to
interact with his/her internal and external environment.
Prolonged Inflammation and Immobilization
Inflammatory response is our body’s natural/normal process of repair following
injury. If all goes well, undue damage does not typically occur and the event
culminates in a positive resolution (e.g. tissue healing, normal repair/remodeling
and recovery of pain-free function). However, the fall-out from excessive or
prolonged inflammation and immobilization constitutes some of the most
prevailing issues we may deal with in our practice.