Time Heals Most Wounds

Few of us consider wound healing until it is thrust upon us in an emergency situation or following a surgical procedure.  Wound healing itself is an extremely active biological process and not a static one.  Consider wound healing activity like a construction site.  The body brings in twice as many supplies as it needs; it reaches a peak at six weeks and then settles down over a 3 to 9 month period. 
There are three phases of wound healing, inflammation, proliferation and maturation.  During the inflammatory phase, which last for the first 4 days, mast cells are attracted to the area releasing histamine.  This chemical attracts the cells of collagen production, fibroblasts, to the area.  Fibroblasts are necessary for wound healing.  In the typical scenario, fibroblast activity reaches a peak at six weeks.  As the signal from the mast cells wanes the final phase of wound healing, maturation is entered.  This phase lasts for 9-12 months.  During this time the scar is remodeled and final wound healing is accomplished.  

As we physically observe wound healing we can only see the visible external signs.   Inflammation is noted by the localized swelling and redness.  This gives way to the proliferation stage and is highlighted by the continued redness of the scar itself along with firmness.  After six weeks the scar then undergoes the remodeling or maturation phase.  The scar will begin to flatten, soften and eventually turn white.  Once a scar has turned white the healing process is basically finished.  This is why a plastic surgeon will typically wait for up to a year before any revision of a scar is contemplated.  

There are two basic types of abnormal scar formation, hypertrophic scars and keloid scars.  The first, a hypertrophic scar, is basically a scar on the far reaches of normal.  This scar will be hard, red and wide.  These scars typically are seen in areas where there is a lot of tension on the wound such as the shoulder and back.  The second scar type, a keloid, is a totally abnormal scar.  It is a scar that grows out of the boundaries of a normal scar and invades and destroys normal skin.  This type of scarring can occur with any skin type.  There is a definite genetic tendency towards this type of scarring.  Basically the signal is never given to stop the proliferation stage of wound healing.  The treatment of keloid scars can involve the use of injectable steroids, pressure bandages and radiation. 

Fortunately most incisions and wound heal well.  Plastic surgeons are well versed with the treatment of all types of scarring.  By following wound healing instructions most scars will heal well.  Those that do not heal well may need additional treatment.