Trauma is defined as the violent severance of the continuity of a tissue due to mechanical, thermal, chemical or radial causes. A scar is the end result of the healing of a wound, following a process known as scarring.
Trauma is defined as the violent severance of the continuity of a tissue due to mechanical, thermal, chemical or radial causes. A scar is the end result of the healing of a wound, following a process known as scarring.
Mechanical injuries are divided into open and closed. Open injuries are defined as those in which there is a disruption of skin continuity, while closed injuries are defined as those in which intact skin covers an area with damage to underlying organs and structures. As far as soft tissue is concerned, wounds are divided into two categories, those without skin loss and those with skin loss. The healthy body reacts to each injury with a sequence of predetermined ‘measures’ designed to heal. Depending on the type of tissue damaged, there may be regeneration (as in the epithelium of the epidermis, bone, vascular endothelium or peritoneum) or simple repair may be the ultimate goal of the whole process (as in nerves).
Once a tissue is injured then the body will try to limit further blood loss and avoid the invasion of pathogens by “closing” the wound as soon as possible. In principle, fibrous tissue appears in the wound area, marking the beginning of the first phase of healing, the inflammation phase. At the same time macrophage cells and lymphocytes migrate to the area starting the histolysis of the necrotic tissues. They then stimulate fibroblasts to produce fibrous connective tissue and collagen, second phase (hyperplasia). Capillaries from the periphery of the wound penetrate the wound and between them the new connective tissue is formed. This tissue in the third phase of remodeling will be transformed into connective tissue with only a few cells and capillaries but rich in fibers which will then become the scar tissue. A tissue can heal, depending on the form of its injury, either in the first or second year. Injuries that heal in the first instance show limited production of fibrous connective tissue, such as injuries without skin loss. Secondarily healed wounds show a high production of fibrous connective tissue, aiming to cover a ‘deficit’, such as wounds with skin loss. In wounds that heal by second intention, in addition to the three phases of healing, two biological mechanisms follow in parallel. These are epithelialization and scar retraction.
The normal healing of a wound is subject to several factors that can affect it, resulting in delayed healing, reduced mechanical stability of the scar and even malformed scars. These factors are divided into local and general factors.
Scars are the result of healing of the loosening of the continuity of a tissue. As far as the skin is concerned, first-time suturing of the wound ensures ideal conditions for healing and aesthetically and functionally acceptable scars. On the other hand, secondary healing often results in wide, aesthetically unacceptable scars with functional disturbances due to their secondary striation, particularly when they are close to a joint. Characteristic features of a scar are:
The mechanism of injury plays an important role in the healing and scarring process. The scar may be the result of an injury, but also of pathological conditions of the skin or other organic diseases. Traumatic scars are a consequence of mechanical, thermal, chemical and radial causes. Dermatological conditions that can lead to scarring are:
In these cases the removal of the underlying cause is required before the appearance of scars. Numerous organic diseases can lead to scarring. Different types of scars result from different mechanisms, different locations and different healing pathways. Thus we have:
