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

Clinical Consideration
In the treatment of pathophysiological scars, the focus inevitably shifts
from ensuring survival to the inclusion of quality of life considerations
such as improved aesthetic and functional aspects of the scar. An aspect of
wound healing that has not been investigated as extensively as others is the
restoration of sensory function and the consequences of changes in
neuroanatomy and function. There is strong evidence for local and
systemic sensory function deficits, such as pruritus, paresthesia and a high
incidence of chronic pain in pathophysiological scars (Hamed et al. 2011).
These considerations warrant due diligence. In addition to sensory
protection provided by proper wound bandaging in the early stages of
healing, successful management of pathophysiological scars ought to
include manual therapy measures aimed at sensory disturbance prevention
and attenuation of mechanoreceptor stimulation.
Mechanotransduction: Wound Healing and Pathophysiological Scars
Like the nervous system, the mechanotransduction pathway is an important cell
communication system that plays a role in wound healing and
pathophysiological scar formation. The mechanophysiological conditions of
injured tissue greatly influence the degree of scar formation, scar contracture,
and pathophysiological scar progression/generation (e.g. keloids and
hypertrophic scars) (Ogawa 2011).
Mechano-biology involves the multiple interactions among cells, the ECM, and
cytokines. Cell surface integrins interface with both extracellular and
intracellular scaffolding proteins. Alterations in the mechanical environment can
therefore be immediately sensed by the cell and converted into a biochemical
signal that can be conveyed throughout the broader expanse of the biotensegrity
system (Ingber 1997, Garg et al. 2012).
The interrelated mechanosensory functions of ion channels, integrins, and
scaffolding proteins play a role in complex signaling cascades initiated by