Wound Healing and Scars

Because healing  processes vary, even a perfect wound closure performed by a skilled physician can result in a scar.  In certain patients, scars can become raised, reddened and firm.  These “hyper” enlarged scars are known as hypertrophic or keloid scars.  People with dark skin or those who tan easily are more likely to develop these types of scars.

Your skin is composed of three layers … The Epidermis (outer layer), Dermis (middle layer) and Sub-Cutaneous (deep layer).  The dermis is the supporting matrix of the skin.  Think of it as the scaffolding supporting the skin.  It provides integrity and structure created by Collagen and Elastin.  When the dermis is traumatized by a deep wound, a scar naturally occurs to bind the edges of the wound together.  All deep incisions or cuts through the dermis will form a scar of some sort.

The normal scar forming process begins with any trauma to the skin which results in bleeding – a sign of injury to the dermis.  As clotting takes place, the bleeding eventually stops.  The blood clot dries and contracts to form an eschar or scab.  Under the eschar, special healing cells called fibroblasts migrate to the site of the injury.

These fibroblasts cover the damaged area and form collagen, which is essentially the building block for scar tissue.  Normally, collagen fibers line up in a parallel fashion like spaghetti noodles in a package, forming a bridge across the wound.  The collagen material continues to remodel for almost two years.  During that time, the bridge of collagen tissue will gradually contract, pulling the edges of the wound tightly together.  This results in a scar that is flat and very thin.

An abnormal scar occurs when too much scar tissue is produced or when the collagen fibers lay down in disarray, much like cooked spaghetti noodles.  These hypertrophic or keloid scars are raised above the rest of the skin and are often reddish in color.  They can itch and cause pain in the worst of cases.

Treatment options for keloid or hypertrophic scars includes occlusive pressure dressing, cortisone injections, surgical removal and laser treatment.  In the late 1980’s the idea of treating scars with Silicone Gel Sheeting was introduced.  Silicone Gel Sheeting is a thick sheet of silicone with a sticky undersurface.  It is applied to the scar with the sticky side down and worn for as long as possible, usually while the patient is at rest.  Since that time, this technology has advanced to include topical silicone gel that can be applied to the skin like a cream.  The gel is much more user friendly and therefore usually more effective, as users are more likely to use as directed.