It was reported that a newborn baby girl had a visible scar on her delicate little face. Could it be infected? Will it leave a scar? How will it affect their daughter’s future life? The parents, in a fit of rage, took the hospital to court. Regardless of the court’s decision, the patient’s parents were most concerned about whether their little “baby” would have a permanent scar on her face.
The author met many patients who came to the clinic because of scars, and the reasons for their scars and scars were different, but the urgency to seek treatment was the same.
Scars not only affect the appearance, but also cause pain and loss of body organ functions.
So, how do these ugly scars form? First of all, when the tissue of our organism is damaged, a blood clot forms in the wound within minutes (this is the time not to remove it artificially and forcibly – because it forms a protective film over your wound, preventing new damage and bacterial invasion). After about 24 hours, capillary endothelial cells in the wound tissue grow into the clot to form new capillaries (so your wound heals with adequate nutrition). 3-4 days later, fibroblasts and capillaries proliferate to form granulation tissue and fill the wound. After that, collagen fibers and nerve endings gradually grow into it, and new epithelium from the epidermis of the skin at the wound’s edge gradually covers the granulation tissue. This results in the soft tissue scars we see in the skin. Over a period of 3-6 months or more, the scar tissue will continue to increase, harden, thicken, become red in color, and become painful and uncomfortable. Thereafter, the scar will generally gradually flatten and soften and lighten in color. The above scar formation process is also the physiological process of wound healing, and the scars formed can be called physiological scars (that is, scars are formed by our organism to heal wounds – they are our friends). Generally speaking, physiological scars do not require any treatment as long as they are not located on a visible part of the body surface, have a color close to normal skin, are not bumpy or deformed, and have no functional impairment.
However, some cases can be not so simple. For example, scars caused by large deep burns, severe trauma, special area injuries, etc. often proliferate for a long time, become hypertrophic, congested, painful and uncomfortable; or contracture occurs, leading to deformation of limbs and organs; or unstable scars that are easily worn and broken are formed. These are all pathological scars and must be treated formally. In addition, some scars, although small in size and not very serious in terms of damage to function, are the reason why many patients strongly request treatment because they directly affect the aesthetics of their appearance.
Scars caused by the same injury are not identical, because the mechanism of scar formation is complex and can be influenced by various congenital or acquired factors. So, who are prone to form more obvious scars?
1. Special physical qualities: The formation of scars in some people’s bodies is not obviously related to the severity of the injury suffered, and minor trauma can also cause serious scars. One of the author’s patients had serious scars due to earring piercing infection and scarring, which seriously affected her appearance and had to be surgically removed.
2. Age: Young adults are in a period of high metabolism, active hormone secretion and high skin tension, and are prone to hyperplastic scars and scars. This type of patients gradually improves with age.
3. Racial differences: The incidence of scars is 6 to 9 times higher in dark-skinned than in light-skinned people, which may be related to the abnormal metabolism of pro-melanocytes.
4. Trauma direction: When the trauma direction is consistent with the natural texture of the skin, the scars are not obvious, and vice versa.
5. Trauma site: Scars caused by trauma to eyelids and mucous membranes are not obvious, while scars caused by trauma to the auricle and the front of the sternum are more obvious.
6. Cause of injury: Scars formed by explosion, burns, etc. are obvious, while scars formed by surgery are not obvious.
In addition, wound infection, repeated stimulation, etc. can also cause scar proliferation to increase.
It is often said that “there are unpredictable events in the sky”. In the course of one’s life, one cannot avoid bumps and bruises, skin inflammation, various surgeries, etc. These will leave scars of different lengths and shapes on the skin, and physiological scars will be found on almost everyone. Once a scar is formed, whether it is physiological or pathological, it will stay with the patient for the rest of his or her life. Only some tiny scars, whose surrounding dermis and skin attachments regenerate and repair, can completely replace the scar tissue without leaving any traces. What can we do if we are unfortunate enough to cause an injury that results in a scar? Broadly speaking, the treatment of scars is divided into two types: surgical treatment and non-surgical treatment. So, which patients are suitable for non-surgical treatment and which patients are suitable for surgical treatment?
Non-surgical treatment has the advantages of being less painful, simple and easy to perform, relatively less expensive, and less likely to cause new scars, etc. It is suitable for patients with small scars, relatively superficial scars or large scars without sufficient skin available at the lesion site to repair the scar after excision, as well as patients with high scarring body who are prone to form new scars after surgery. Commonly used non-surgical treatments include
Hormonal therapy: Applying an ointment containing steroids to the nascent scars or injecting steroid hormones such as desmopressin acetate into the scars can cause hyperplastic scars and scars to atrophy and flatten. However, the systemic side effects of steroid hormones should be noted.
Cryotherapy: Small proliferative scars can be treated by liquid nitrogen spray method or cryoprobe contact method.
Radiation therapy: The use of soft X-ray superficial radiotherapy and radium radiation therapy can flatten hyperplastic scars or scar bumps, disappear neovascularization and lighten the color.
Scar softening creams: For newborn hyperplastic scars and post-surgical incision scars, with softening and anti-itching effects.
Ultrasound and wax therapy: It is useful for hyperplastic scars.
Compression therapy: Compression with elastic bandage and elastic sleeve not only has the effect of preventing the occurrence of scars, but also its effect of treating hyperplastic scars is good.
However, if your scars are larger, deeper, and seriously affect the function or appearance of your body, then your doctor will recommend that you should preferably undergo surgical treatment. Clinically, we commonly use the following procedures for scar treatment.
Abrasion: Skin Abrasion can treat depressed scars left by smallpox, chickenpox, and seat sores, can grind down small hyperplastic scars, and can remove pigmentation from flat scars.
Surgical excision and repair: Small scars can be surgically excised and the incisions sutured. Larger scars that cannot be directly pulled together and sutured after excision will require free skin graft repair. After excision of scars with large and deep areas involving composite tissue defects, skin flaps, myocutaneous flaps with tips or free anastomotic vascular grafts are often required.
Skin expansion therapy: The skin is first expanded with an expander and then the scar is excised, and the expanded skin is transferred to cover the wound repair. This method is currently more clinically used and quite popular because it expands the normal skin around the scar and transfers the new and extra skin to the trauma left after scar excision. The repair effect is similar to the color and texture of normal skin.
In addition, a new high-tech method, tissue-engineered artificial skin, is currently under research. It is expected that in the near future, artificial skin made of tissue engineering technology close to natural human skin will be used for clinical treatment of scar repair after excision. At that time, patients with large scars who must have skin implants will be able to avoid the pain of “digging up flesh and mending sores”.
An important discovery in scientific research shows a promising future for scar prevention and treatment. In the 1970s, scientists discovered that no scar formation after fetal skin wound repair and proposed the concept of “scarless healing”. Current research shows that scarless fetal healing is related to its own special physiological state and unique environment, such as immature autoimmune system and mild inflammatory response to trauma; amniotic fluid is rich in prostaglandins, hyaluronic acid and other factors related to wound healing; the fetus is in the womb and its tissue oxygen partial pressure is low. However, the exact mechanism of scarless healing is not yet clear, and breakthroughs in this area of research will provide an effective way for humans to realize the dream of scarless skin healing.
What can we do in our daily life to prevent and reduce the formation of scars? First of all: we should be aware of self-protection and try to avoid causing unnecessary injuries – in fact, most of the injuries can be avoided if we pay attention to protection in general. Secondly, once an injury is caused, it should be treated early. In addition, treatment of scars should be treated with care, and it is best to follow the doctor’s advice rather than taking some incorrect treatment on your own, causing scars to deepen and intensify.