The human body can sustain a variety of injuries such as burns, cuts, and knocks or bangs. Well, all of these aggressions initiate an orderly sequence of steps that are involved in the healing response, in which the normal healthy tissue (skin) is replaced by connective tissue (scar). The healing response is also characterized by the movement of specialized cells into the injury site.
The restoration of anatomical continuity and function is the result of the complex and dynamic process of healing. After an injury, your body can respond in 4 different ways:
1.Regeneration (exact replacement)
The skin regeneration process occurs when there is loss of structure and function. Our body is so incredible, that it has the complex ability to restore that structure by replacing exactly what was there before the damage. Smaller forms of life, such as the salamander and crab, can regenerate tissue in this way. As man has evolved, we have lost this ability and can only recuperate a limited amount of damaged tissues by the process of regeneration.
2. Normal repair (reestablished equilibrium)
Normal repair is the response where there is a re-established equilibrium between scar creation and scar remodeling. Most humans generate this type of response following an injury. The pathological response to tissue damage stand in sharp contrast to the normal repair response.
3. Excessive healing (fibrosis and contractures)
In excessive healing there is an exaggerated deposition of connective tissue that results in altered structure and, thus, loss of function. Fibrosis, structures, adhesions and contractures are consequences of exaggerated healing. Keloids and hypertrophic scars in the skin are examples of fibrosis. Contraction is normal during the process of healing but if exaggerated, it becomes pathologic and is called a contracture.
4. Deficient healing (chronic ulcers)
Deficient healing is the opposite of fibrosis; it appears when there is an abnormally low deposition of connective tissue matrix and the tissue is weakened to the point where it can fall apart. Chronic uncurable ulcers are examples of deficient healing.
The Scar Healing Process
Just as an injury occurs, several different cells are sent to the damaged site, and the complex healing process begins.
The normal healing cascade commences with an coordinated process of hemostasis and fibrin deposition, which leads to an inflammatory cell cascade, characterized by neutrophils, macrophages and lymphocytes within the tissue. This is followed by migration and proliferation of fibroblasts and collagen deposition, and finally remodeling by collagen cross-linking and scar maturation. Despite this coordinated sequence of steps responsible for normal wound healing, abnormal reactions leading to fibrosis or chronic ulcers may occur if any step of the healing sequence is altered.
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