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

Clinical Consideration
Preventive measures are a major priority and need to be applied before,
during and immediately after wound closure. Reducing mechanical tension
in and around the scar is a significant consideration in terms of prevention
of contractures, hypertrophic and keloid scars. Medical treatment of
pathophysiological scars includes removal of the bulky scar tissue by
reconstructive surgical techniques and/or injection of substances, such as
collagenase, that promote collagen breakdown (Monstrey et al. 2014).
Recall from Chapter 5: during wound healing, continuous or cyclical
loading (brief, light stretch or compression – lengthening <30%) of
mechanosensitive tissues stimulates resident fibroblasts to secrete
collagenase (Tortora et al. 2007) reducing the potential of excess collagen
formation (fibrosis and pathological cross-linking). Cyclical
stretch/compression – involving approximately 10% of available tissue
elasticity – doubles collagenase production, whereas continuous stretching
appears to be 50% less productive (Carano & Siciliani 1996, Langevin
2010). And repeated, low amplitude tissue stretch seems to elicit an antiinflammatory
response (Yang et al. 2005).