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What is a scar? | Scar Series

A scar is an area of fibrous tissue that forms to replace or repair injuries which can occur to your skin and any other of your body’s tissues. Wound healing is the process in which a scar is made and is a very dynamic process. The wound healing process can be divided into 3 different phases. The process itself is very complex and not linear in nature. Wounds can progress forwards and backwards through each of the phases of healing depending on the intrinsic and extrinsic forces being exerted on the patient.

The phases of wound healing are:
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  • Inflammatory
  • Proliferative
  • Maturation

The inflammatory phase of wound healing is the body’s initial response to injury. During this phase blood vessels in the area of injury contract helping to form a clot to achieve hemostasis. It is after this initial period that the blood vessels will begin to dilate. This allows for white blood cells, growth factors, and other components of healing to reach the area of wounding. It is during this time that the wound will be erythematous, warm, swollen, and painful. This inflammation is necessary so that the patient’s neutrophils and macrophages may enter the wound and mount a response to the injury. These cells are responsible for the removal of devitalized and necrotic tissue from the wound.

During the proliferative phase the patient’s wound is rebuilding. It is filling the wound with granulation tissue which is comprised of collagen and extracellular matrix, which is an amorphous gel like material that fills the spaces between cells and contains interstitial fluid and proteoglycans. The fibers consist of collagen, elastin and reticular fibers. It is into this melee that new blood vessels will develop in a process known as angiogenesis. Through angiogenesis the body will deliver the much needed blood that supplies the nutrients and oxygen needed for the cells known as fibroblasts to produce this vital healing tissue. Once the wound has been filled with granulation tissue the epithelial cells can re-epithelialize or resurface the wound.

The final phase of wound healing is known as maturation. This occurs after the wound has been closed. During this phase the immature scar tissue is remodeled and in essence the type III collagen which has been initially laid down is converted to type I collagen. As this occurs there is also a decrease in the number of blood vessels that are seen in the area of the wound.

Therefore your scar tissue is composed of the same protein, collagen, as the tissue that it replaces, but the fiber composition of the protein is different. Scarring is therefore a natural part of the healing process. Its appearance and its treatment depend on multiple factors.

Factors which affect the appearance of scars:

  • Depth of the wound
  • Location of the injury
  • Size of the wound
  • Age of the patient
  • Genetics
  • Sex
  • Ethnicity

The wound can be due to surgery, infection, burns or any other trauma, but if it penetrates the full thickness of your skin, it will leave a scar. It is important to recognize that the scar is your body’s “glue”. Without scar we cannot heal. The truth of the matter is that scars will never go away. But there are some methods at our disposal that can help reduce a scar’s size and change its appearance.