Scar formation is part of the body’s natural repair mechanism and usually begins during the skin repair process after an accidental injury, surgery or a wound due to a disease. The more severe the skin injury, the longer it takes to repair and the greater the chance of visible scars forming.
The formation of scars can be related to factors such as age, the part of the body that was injured, and genetics. Younger skin is more prone to overgrowth as the wound heals, and the scar is usually larger and thicker in size. Typically, scars will appear as redness and elevation on the surface of the healing wound, which will slowly fade and flatten out over time.
The proliferation of scar tissue not only changes the appearance of the skin, but sometimes causes certain movement disorders.
Scars typically take 18 months or more to flatten and slowly fade in color. On the downside, problematic scars may have the following effects: proliferate and keep growing; have a persistent red or black color that does not fade; cause discomfort, itching or pain; limit joint movement; and cause psychological disorders due to appearance.
Scar classification and treatment.
1.Superficial scars
Etiology: A kind of superficial skin scars, often formed after light abrasions, superficial infections or superficial second degree burns on the skin.
Symptoms: These scars are slightly different from the normal skin in appearance, but are locally flat and soft, and have no obstruction to the body.
Treatment: Generally no treatment is needed.
2.Depressed scars
Causes: Sores, surgery, trauma, infection, chickenpox and smallpox
Symptoms: The scar is depressed and lower than the surrounding normal skin surface. If the scar only involves the superficial layer of skin and subcutaneous tissues, the depression is shallow and mostly affects only the appearance without any functional disorder. If the scar involves deeper tissues such as muscles, tendons, and periosteum, the basal long adhesions are tighter and often prevent functional activities. If the scar is attached to nerve tissue, pain may occur.
Treatment: For small and shallow depressed scars, the epidermis of the scar can be eliminated and the deeper tissues can be preserved for filling, and the subcutaneous tissues on both sides of the scar can be separated and the wound edges can be directly sutured to make the depression disappear and improve the appearance. For deeper depressed scars with smaller areas, after excision of the scar, local fat flap or muscle flap transfer, or implantation of dermis, fat, fascia, cartilage or tissue substitutes are used according to the situation, and subcutaneous sutures are made after sufficient superficial separation on both sides of the trauma edge to flatten the depression. For larger and deeper depressed scars, the scar surface after excision cannot be directly sutured and needs to be repaired with skin flaps, muscle flaps or skin tubes, etc., and deep tissue defects are repaired at the same time or later, in order to restore function and appearance.
3.Atrophic scars
Etiology: An unstable scar tissue formed after the healing of a large area of deep burn or chronic ulcer wound, also known as unstable scar.
Symptoms: Atrophic scars are flat, smooth and shiny surface, or hypopigmented showing pale. Or the pigmentation is dark brown, or pale and dark brown appear simultaneously in the same scar. The texture is tough and soft, with a loose base that can be lifted and pinched. These scars are usually found on the face and chest and back and are generally stable and do not cause functional impairment.
Treatment: Generally, no treatment is needed. If the scar is located on the face, it often hinders the appearance due to the difference in color. If the scar area is small, it can be sutured directly after excision, or excised in stages. If the area is larger, skin expansion can be applied and local flaps can be transferred to repair the wound after excision of the scar to improve the appearance. If the atrophic scars are not very stable, or if they are adhered to deep tissues and impair the function, scar tissue should be excised and flap grafting should be applied to repair them.
4.Proliferative scars
Etiology: Also known as hypertrophic scars, they usually occur at the site of deep second-degree burns where the subcutaneous tissue is not damaged and heals on its own, and also at the gap between skin pieces after healing of third-degree burn wounds by stamped skin implants, and on the edge of general incisions after suturing (such as after heart surgery).
Symptoms: This scar is raised above the skin surface and is irregular in shape. In the early stage, it is locally thickened and hardened, with extremely congested capillaries, flushed or dark purple, and painful and itchy locally. This memorial proliferation phenomenon gradually subsides and atrophies after a considerable period of time, local congestion improves, tissues become softer, some can eventually flatten out, scars become shallow, pain and itching symptoms are reduced to disappear, they can be pushed, generally should not be contracted, and functional impairment is reduced.
Treatment: Elastic compression bandaging is one of the more effective measures to prevent or reduce scar hyperplasia. For small hyperplastic scars, the application of local injection of adrenocorticotropic hormone or local radiation therapy also has certain effect. The timing of surgery should generally be avoided in the acute proliferation and congestion phase of scars, but in functional areas such as hands, appropriate advancement should be considered to avoid joint stiffness and secondary deformities. The principle of surgery is to initially proliferate the scar, release the contracture, and repair the trauma with skin graft.
5.Contracture scars
Etiology: It mainly occurs when the trauma of deep burn skin defect heals by itself, or caused by linear scars in functional areas.
Symptoms: There are two main aspects of skin wound healing: one is the centripetal contraction of the wound edge, and the other is the crawling of the surrounding epithelium toward the center of the wound. With the centripetal contraction of the trabecular edge, the skin around the wound is also pulled and driven toward the center of the wound. If the surrounding skin is wide and loose, it can be adapted by local tissue adjustment without seriously affecting the function or appearance when its compensatory limit is not exceeded. If it occurs in the face where the body surface organs are concentrated, the compensatory ability of the skin is poor, and a slight pulling and moving will result in deformity and dysfunction of the external appearance, such as eyelid ectropion and crooked corners of the mouth. If the scar contracture occurs in or near the joints of the limbs with a large range of activities, or in front of the neck or perineum, it will easily cause functional disorders, such as contracture and flexion of the upper and lower limbs or cervicothoracic adhesions. Over time, it may also lead to shortening or displacement of nerves, blood vessels, tendons, deformation and dislocation of bones and joints, etc. If it occurs in young age without timely treatment, it may hinder its normal development and lead to deformity.
Treatment: Excision and release of the scar, complete release of the contracture, and repair of the wound by means of implantation. After the trauma is healed, elastic traction support bureau is applied and functional exercises are performed in time. For poof or linear scars, if the skin on both sides of the scar is relatively normal and has a certain degree of loosening, Z-plasty or W-plasty can be used to release the contracture, or can be combined with skin grafting.
At present, there are two main categories of anti-scar hyperplasia treatment methods in the international arena.
Compression therapy: wearing the appropriate elastic sleeve. Three elements of scar compression therapy: “early”: start compression as early as possible after the wound heals, “tight”: pressure is high enough, when continuous pressure exceeds 3.3 Kpa, due to local hypoxia, cellular response decreases, collagen metabolism decreases, and fibroblast proliferation is inhibited. “Long”: the treatment should be long-lasting, and the pressure treatment should be continued for more than six months until the scar no longer turns red and hardens after removing the pressure bandage.
Topical silicone preparations: silicone preparations are currently used more Shu scar (silicone cream), gold Bark, beauty skin care, scar enemy, etc. The first two are ointments, the latter two are films containing silicone preparations, the effect on hyperplastic scars is relatively good, affected by the location of the scar it, some places are not stick.
Observation of the disease process: pay attention to the changes of scar size, color, hardness and itching of the patient during the treatment.
Conclusion.
All anti-scar treatments are to inhibit the growth of scars to varying degrees, but complete removal of scars is basically impossible, and it is necessary to adhere to anti-scar growth and pigmentation treatment, pay attention to the protection of scars and pigmentation, pay attention to local cleanliness, avoid sun exposure and high temperature work, and avoid scratching scars, which may lead to ulceration and formation of chronic ulcers or even cancer.