The Anatomy of Scar Tissue

Scars. We probably all have at least one. But what exactly is a scar and why do we get them?

What Is A Scar?
A scar is a mark left in skin or organs by the healing of a wound or injury. It is the replacement of tissue by connective tissue.

Connective tissue is made up of collagen, a fibrous protein commonly found in bones, ligaments and cartilage. It is also the result of the inflammation process present in healing.

When the collagen used for tissue mending matures, it is referred to as scar tissue. It forms to fix the continuity of the tissue, but it is approximately 20 per cent weaker than the original tissue. And because of its different physical makeup, scar tissue presents as red or purple in the beginning stages. As it matures, it becomes white and glistening.

The most commonly known scars are those seen on the skin from cuts or wounds, but scarring occurs with any tissue damage, inside and outside of the body. In fact, anything from a simple paper cut to micro-tears of muscle fibers from overstretching forms scar tissue.

Every Scar Is Not Created Equal
Scar tissue is dependent on the individual, the nature and severity of the injury and complicating factors. When the edges of a cut or tear can be approximated through tape, staples or sutures, primary healing occurs. Because of the body’s efficiency, this method results in minimal scarring due to the small amount of collagen required to repair the tissue.

Secondary healing occurs when the wound’s surface area is too large or involved for proper approximation. Healing time and collagen production are increased. This results in heightened scarring.

When ample scarring occurs, a contracture or shortening of the connective tissue can occur. The result is tissue that cannot adequately lengthen, which can greatly reduce motion of the area. Usually lengthening can be restored with proper exercise or stretching of the area. Irreversible contractures, when fibrous tissue or bone replaces the connective tissue, can result in permanent loss of motion. Motion can only be restored by surgical intervention.

Occasionally, these shortened or contracted areas will produce adhesions.
An adhesion is a cross-link of the collagen-based connective tissue in a random pattern. It is usually treated with massage techniques and stretching protocols. Chronic inflammation however, can cause fibrotic adhesions, which can severely restrict motion. Fibrotic adhesions are very difficult to diminish.

Sometimes chronic inflammation and abnormal healing can result in what is called proud flesh. This is the red, raised scarring from collagen formation that is disorganized. These scars are more likely to become damaged since normal healing will not occur over these elevated welt-like scars. Sometimes, surgical intervention may be necessary to remove the abnormal tissue to give way to proper healing.

A scar that extends beyond the boundaries of the damaged area is referred to as a keloid. A keloid is excessive collagen forming in a random pattern, which may continue to grow for several years. Typically, keloids are best treated with corticosteroids rather than surgery. Corticosteroids are effective in reducing the keloid, but due to the imbalance of collagen, keloids often reoccur.

Keloids are often referred to as hypertrophic scars, but in fact the two are somewhat different. Hypertrophic scars are also the result of collagen formation beyond the boundaries of the wound. However, the fibers are arranged in a circular pattern and are typically seen in second or third degree burns as a result of secondary healing. These scars are also seen with skin graft donor sites and are often a result when an infection complicates burn healing. These scars or small portions of a larger scar can be removed surgically so approximation can be attained or skin grafting can be performed.

Who Is At Risk?
We all scar. But the extent of scarring can be the result of many things. African American or Asian people, for example, are more prone to hypertrophic or keloid scarring. And over 85% of hypertrophic and keloid scars are seen in people under the age of 30 because of increased collagen production.

Areas like the upper back, the shoulder, the buttocks and the bottom of the foot are more likely to develop hypertrophic scarring, whereas keloids are more common from your neck to your torso and from your shoulder to your elbow.

Complications, such as infection, that impede healing can also increase the amount of scar tissue. Too much tension on a healing wound can also increase scar formation. Tension or excessive stretching can produce ongoing micro tears, which perpetuates the inflammation process.

How To Minimize Scar Tissue
Your first step to minimize scarring is proper first aid, followed by consistent care during the entire healing process. Proper care of complicating factors such as infections or medical conditions, which affect healing, can assist in proper recovery. Alleviating the swelling associated with the inflammation process can limit the effects of scarring. Also, increasing circulation to allow necessary nutrients and cells into the area can minimize the size of scars.

Massage before the collagen fibers mature can reduce overgrowth, thus decreasing hypertrophic scarring, but should only be performed by a trained therapist. Stretching should not be performed during healing so as to avoid further stress on the area. However, gentle, partial range of motion without pain is acceptable to maintain flexibility of the area.

Once healing is complete, softening of the scar tissue by stretching and massage can greatly limit motion restrictions. Hypersensitive or painful scars may require desensitizing through tactile stimulation such as touching, brushing and pressure before stretching and massage can be tolerated.

If you think there is a problem with healing or your scar is bothersome, consult with a qualified medical professional. Scars are a normal part of the body’s amazing ability to heal itself. They are a testament to our individuality!

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