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Wound healing - the surgical scar

If the skin is injured by an external influence, a wound is created.

The body responds to an injury with a series of carefully coordinated steps aimed at closing the wound and healing.

In the case of skin wounds, however, the body can only "repair". The resulting "gap" is first closed with a blood clot and then filled with connective tissue from the inside - a scar is created.

Hair, sebum or sweat glands are also not newly formed in the scar tissue.
The scar tissue also has less elastic fibers (collagen), so that it can shrink and harden: the scar can pull itself inwards.
The scar tissue has less blood flow and the tissue contains less water.

Well-cared for surgical operation wounds with smooth wound edges that are very close together usually heal quickly and easily.
The scars, which were still reddened in the first few weeks, gradually fade until after several months they can hardly be distinguished from the skin.
The correct behavior of the patient in the postoperative phase can go a long way towards creating beautiful scarring. What needs to be considered after the operation is discussed individually with the surgeon.

But healing is not always that smooth. Wounds in which larger areas of skin are affected (e.g. with penoid build-up) require a much longer healing time. Here, too, connective tissue fills the defect.
A noticeable and also cosmetically unsightly scar is often left behind.
Some scars cause problems during and after the healing process: They do not close properly, become bulging and hard, they become tense.

Problem scars include:

Atrophic scar
The wound heals poorly, the formation of new connective tissue fibers is insufficient. The result is a "sunken" scar that lies below the skin level.

Hypertrophic scar
It occurs shortly after the wound has healed or while it is still in progress.
There is an overproduction of connective tissue fibers. The scar tends to bulge, it rises above the surrounding skin level, but remains basically limited to the original injury area.

Hypertrophic scars can occur especially if the wound is not immobilized or spared, or if an infection also occurs.

Keloid scar
It only arises after a long time after the wound has healed through strong overproduction of connective tissue fibers, which always proliferate like crab claws beyond the wound area into the healthy tissue. This mainly affects adolescents and young adults of the female sex.
Scars on parts of the body that are exposed to great skin tension also tend to form keloid. This tendency is relatively often inherited.
Furthermore, people with dark skin are about ten times more likely to develop keloids than people with light skin color.

Faster wound healing with fewer scars (10.2003)
A drug to help wounds heal faster with fewer scars has been developed by British scientists. The remedy has already been tested on humans and could be used in the future after operations to prevent the formation of scars.
With a special substance, the agent attracts cells that are involved in the regeneration of the skin, report the scientists working with Mark Ferguson from the University of Manchester in the British science magazine "New Scientist".

Faster and better healing
The researchers led by Mark Ferguson had therefore inflicted two wounds on each of the arms of more than 300 volunteers. They injected an ineffective dummy drug into one wound and the agent containing the growth factor TGF-beta-3 into the other wound.
In comparison, the wounds with the new substance healed faster and left fewer scars, Ferguson told the magazine. The product is not yet on the market.

TGF-beta-3
The researchers found TGF-beta-3 while examining wounds in mammalian fetuses that healed without scars.
A high proportion of the growth factor was found in these wounds. This would attract two cell types that migrate into the injured skin to heal.
Ferguson suspects that this causes the skin to regenerate so quickly that no scars can develop.

Another new development for improved wound healing
A special gel that is being researched by another team of British and New Zealand scientists is also promising faster wound healing with fewer scars.
They developed a gel that inhibits the production of the protein connexin43. This protein plays a key role in communication between cells.
By suppressing his "messages", wounds inflamed less, which also results in less scarring and allows wounds to heal more quickly. The scientists presented their study in the US journal "Current Biology".

Faster wound healing with fewer scars, source: science.org
Letzte Bearbeitung: 25.10.2021, 01:12

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