Introduction edit
Scar improvement, and scar-free healing are an important and relevant area of medicine. During the 90's published research on the subject increased, it’s a relatively recent term in the literature. Scar free healing is something which takes place in foetal life but somehow the capacity is lost during progression to adult. It occurs in amphibians for tissue regeneration, for example skin regeneration in the adult Axolotl [1].
Scar Vs Scar Free Healing edit
Scarring takes place in response to damaged or missing tissue following injury due to biological processes or wounding, it is a process that occurs in order to replace the lost tissue [2]. The process of scarring is complex, it involves the inflammatory response and remodelling amongst other cell activities. Many growth factors and cytokines are also involved in the process, as well as extracellular matrix interactions [2]. Mast cells are one cell type which act to promote scarring [3].
There are a number of problems with scar healing, both physical and psychological, scarring is a significant clinical burden which is why scar free healing is a concept of interest. Some of the problems in scar healing lie in the physical outcome of the process for example when collagen is abnormally organised in scar tissue. In scars the collagen is arranged in parallel bundles of the collagen fibres whilst healthy scar free tissue has a “basket weave” structure (Figure 1) [2]. The difference in collagen arrangement along with a lack of difference in the dermal tissue when healing has taken place with or without scarring is indicative of regenerative failure of normal skin [2]. Severe scarring resulting from these collagen deposits is known as hypertrophic scarring and is a big problem worldwide with an incidence ranging from 32%-72% [4] Visible scarring can cause psychological trauma, the burden of both this and the after care and other physical issues with scarring are discussed later.
References edit
- ^ Seifert, Ashley W.; Monaghan, James R.; Voss, S. Randal; Maden, Malcolm (2012-01-01). "Skin regeneration in adult axolotls: a blueprint for scar-free healing in vertebrates". PloS One. 7 (4): e32875. doi:10.1371/journal.pone.0032875. ISSN 1932-6203. PMC 3317654. PMID 22485136.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ a b c d Occleston, Nick L.; Metcalfe, Anthony D.; Boanas, Adam; Burgoyne, Nicholas J.; Nield, Kerry; O'Kane, Sharon; Ferguson, Mark W. J. (2010-01-01). "Therapeutic improvement of scarring: mechanisms of scarless and scar-forming healing and approaches to the discovery of new treatments". Dermatology Research and Practice. 2010. doi:10.1155/2010/405262. ISSN 1687-6113. PMC 2929503. PMID 20811598.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Ud-Din, Sara; Volk, Susan W.; Bayat, Ardeshir (2014-09-01). "Regenerative healing, scar-free healing and scar formation across the species: current concepts and future perspectives". Experimental Dermatology. 23 (9): 615–619. doi:10.1111/exd.12457. ISSN 1600-0625. PMID 24863070.
- ^ Gangemi, Ezio Nicola; Gregori, Dario; Berchialla, Paola; Zingarelli, Enrico; Cairo, Monica; Bollero, Daniele; Ganem, Jamal; Capocelli, Roberto; Cuccuru, Franca (2008-04-01). "Epidemiology and risk factors for pathologic scarring after burn wounds". Archives of Facial Plastic Surgery. 10 (2): 93–102. doi:10.1001/archfaci.10.2.93. ISSN 1521-2491. PMID 18347236.