Bad Scars Can Happen

Almost no one gets through life without scar. If you have, well then consider yourself lucky. Most of us go through the entire healing process and never consider any of the wonderful mechanisms in our bodies that allow this process to take place. As a plastic surgeon I am intimately involved with all aspects of wound healing and there are several things that a person can do to get the best result possible. 

The mechanism of injury is very important.

• Crush  - Many times we see a patient who has sustained a crush type injury. This occurs when the tissue is trapped between two hard surfaces. This can occur due to a fall. Initially the wound can appear jagged and uneven with possible beveling of the edges. What you cannot see is the surrounding zone of trauma. That tissue and skin that has been damaged and will eventually demarcate and slough. The best that can be done in the emergency situation is to wash out the wound as thoroughly as possible, removing all foreign material and approximate the edges with any number of suture techniques. These wounds if severe will need a revision in the future.  
• Straight Cut - This is the standard injury a straight line cut with a relatively sharp object such as a piece of glass or knife. There will be minimal damage to the surrounding edges and the wound will heal in a more predictable manner.

All injuries go through three stages of healing, inflammation, proliferation and maturation. Every individual will heal a there own pre-determined rate. Healing is as individual to each person as their fingerprint. 
The three stages of healing are as follows: 

• Inflammation - This begins with the injury and continues to the end of the fourth day. It is basically when the scar is red and angry. This is a normal part of the very cellular process of wound healing.  
• Proliferation - This is the very active period of wound healing. Think of this like a constructions site. Many different types of cells such as mast cells and fibroblasts are being attracted to the wound bringing with them the building blocks of scar formation. This phase last through the end of the sixth week and is highlighted by a firm, hard, red scar. 
• Maturation - After the proliferation phase the scar undergoes maturation or remodeling phase. This begins at the end of the sixth week and can continue on for another six, nine or twelve months. The body produces enzymes that remodel the scar, flattening it down softening it up. Once the scar turns white the process is done. It is only at this point that it can be properly evaluated by a plastic surgeon for a possible revision.

A good working knowledge of wound healing is essential for satisfactory healing. By understanding the different phases of healing is possible to develop a plan that will yield the best possible result. Careful cleansing, taping and massage can change the way a scar forms. It is typically to begin scar massage at the end of the third week. Attention to detail is essential to a great result.