The human body can sustain a variety of wounds such as burns, cuts, and knocks or bangs. Well, all of these aggressions commence an orderly sequence of steps that are involved in the healing response, in which the normal functional tissue (skin) is replaced by connective tissue (scar). The healing response is also characterized by the migration of specialized cells into the injury site.
The restoration of anatomical continuity and function is the result of the complex and dynamic process of healing. There are four basic responses that can result after an injury:
1.Regeneration (exact replacement)
Skin regeneration occurs when there is loss of structure and functionality. Our body is so incredible, that it has the complex capacity to replace that structure by replacing exactly what was there before the damage. Smaller forms of life, such as the salamander and crab, can regenerate tissue in this manner. As man has evolved, we have lost this capacity and can only replace a limited amount of injured tissues by the process of regeneration.
2. Normal repair (reestablished equilibrium)
Normal repair is the response where there is a re-established equilibrium between scar formation and scar remodeling. This is the usual response that most humans experience after an injury. The abnormal response to tissue damage stand in sharp contrast to the healthy repair response.
3. Excessive healing (fibrosis and contractures)
In excessive healing there is an exaggerated deposition of connective tissue that results in altered structure and, thus, loss of functionality. Fibrosis, structures, adhesions and contractures are examples of exaggerated healing. Keloids and hypertrophic scars in the skin are examples of fibrosis. Contraction is normal during the process of healing but if exaggerated, it becomes pathologic and is called a contracture.
4. Deficient healing (chronic ulcers)
Deficient healing is the opposite of fibrosis; it exists when there is an abnormally low deposition of connective tissue matrix and the tissue is weakened to the point where it can fall apart. Chronic uncurable ulcers are examples of deficient healing.
The Skin’s Own Scar Healing Process
Just as an injury occurs, several different cells are sent to the damaged site, and the complex healing process begins.
The normal healing cascade begins with an orderly process of hemostasis and fibrin deposition, which initiates an inflammatory cell cascade, characterized by neutrophils, macrophages and lymphocytes within the tissue. This is followed by attraction and synthesis of fibroblasts and collagen deposition, and finally remodeling by collagen cross-linking and scar maturation. Despite this orderly sequence of steps leading to normal wound repairing, pathologic reactions leading to fibrosis or chronic ulcers may occur if any step of the healing sequence is altered.
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