scar
Introduction
Scar introduction Scar is a very general concept, which is a general term for the appearance and histopathological changes of normal skin tissue caused by various traumas. It is a normal and inevitable physiological reaction in the natural healing process of wounds or wounds after human trauma, and is also the inevitable result of the wound healing process. The essence of scar is an abnormal, unsound tissue that does not have normal skin tissue structure and physiological functions, and loses normal tissue vitality. Scars not only destroy the beauty of the body, but also hinder the physiological functions of related tissues or organs, and even lead to deformities. basic knowledge Sickness ratio: 80%-95% Susceptible people: no specific people Mode of infection: non-infectious Complications: keloids
Cause
Scar cause
Trauma (95%):
Scar is an inevitable outcome of the process of human wound repair. In a broad sense, there is no wound healing without scars. The main component of scar tissue is fibrin. The production and deposition of scar tissue collagen increases the strength of the wound and is generally beneficial. If the scar tissue is not formed enough, the damaged tissue can not get normal tension, which can cause many complications, such as scarring of the abdominal wall incision healing, and the scar can be re-cracked or the abdominal content under the action of intra-abdominal pressure. The material gradually bulges outward to form an abdominal wall. Conversely, if the scar is excessively formed, it can cause serious physical or functional problems. The hazard of scar depends on its nature and characteristics, as well as the secondary fixation of deep tissue. Thus scars are always an imperfect replacement relative to pre-injury tissue. From a mechanical point of view, its resistance is weakened; from a nutritional point of view, it causes obstacles to the exchange of oxygen and nutrients; from a functional point of view, the deformity and dysfunction of damaged tissue are aesthetically pleasing, resulting in a shape The destruction.
Prevention
Scar prevention
1. The first step in preventing scars is proper wound care. Whether it is trauma, burns, skin infections or surgery, scars will develop after wound healing. Correct wound care can avoid abnormal scars.
2. After the wound is removed or the wound is initially healed, massage therapy and compression therapy are started as appropriate.
3, with a cosmetic adhesive tape or silicone film pressed on the healing wound, the cosmetic adhesive paper should be adhered to 24 hours a day, the silicone film should be attached for about 12 hours, the pressure must be larger than the wound itself and include the surrounding normal skin. Only effective.
4. Compression therapy can reduce the strength of the wound to stretch outward, making the scar more flat and thin.
5, massage therapy can soften the hard palate, and the effect of tissue expansion, can improve the bulge or scars with a tendency to collapse.
6. For large-area wounds, consider the compression treatment of tight-fitting elastic clothing.
Complication
Scar complications Complications keloid
If the scar tissue is not formed enough, the damaged tissue can not get normal tension, which can cause many complications, such as scarring of the abdominal wall incision healing, and the scar can be re-cracked or the abdominal content under the action of intra-abdominal pressure. The material gradually bulges outward to form an abdominal wall. Conversely, if the scar is excessively formed, it can cause serious physical or functional problems. The hazard of scar depends on its nature and characteristics, as well as the secondary fixation of deep tissue. Thus scars are always an imperfect replacement relative to pre-injury tissue. From a mechanical point of view, its resistance is weakened; from a nutritional point of view, it causes obstacles to the exchange of oxygen and nutrients; from a functional point of view, the deformity and dysfunction of damaged tissue are aesthetically pleasing, resulting in a shape The destruction.
Symptom
Scar symptoms common symptoms scars body scars itching contracture scars scar scar scar formation scar hyperplasia scar atrophy depression superficial scar
Hypertrophic scar
These scars in the foot often occur after the wound healing of deep burns. Reticulated hypertrophic scars are also common in sutures around the skin after skin grafting of the III degree burn wound. In addition, the most common is that any incision scar after suturing is also included in this type.
Hypertrophic scars are characterized by prominent surfaces, irregular shapes, uneven heights, flushing and congestion, and firmness. It has a burning and itching sensation. Hypertrophic scars are manifested by increased ambient temperature, emotional agitation, or increased symptoms when eating spicy food. Hypertrophic scars often last for months or years before degenerative changes occur. The characteristics of this scar are: early local swelling and hard congestion, its tissue structure is covered by a layer of atrophic epithelial cells, the middle layer is vasodilatation, and there is inflammatory cell infiltration, the bottom layer is less collagen fiber and a large number Connective tissue hyperplasia. This scar is higher than the surface of the skin, with early local thickening and hardening, and capillary congestion is red or dark red. The base of the scar generally does not adhere to the deep tissue, can be pushed, and has less contractility, and most of them do not cause serious dysfunction, but affect the beauty in the face and exposed parts, so there is often a need for treatment.
Keloid
Keloid is a kind of connective tissue tumor on the skin. It is a scar characterized by persistent strong hyperplasia. It is often manifested as a crab-like infiltration of the surrounding skin. The lesion is raised from the skin and is uneven. The shape is irregular, the quality is hard and tough, and it is very uncomfortable.
Characteristics of keloids:
1. Systemic factors may play a major role, especially specific physical factors, which sometimes exhibit genetic characteristics. The keloids in these patients are often not related to the severity of skin damage, and even minor trauma, such as mosquito bites, vaccination and other needlestick injuries can form keloids.
2. Ethnic differences: According to statistical analysis, the incidence of keloids in dark-skinned people is 6 to 9 times higher. May be associated with abnormal metabolism of melanocyte stimulating hormone.
3. Significantly good site: common in sternum, shoulder deltoid muscle, auricle, lower jaw, upper back.
4. The lesion is long, and the growth is not degraded for many years. As the lesion progresses, the scar extends beyond the original base and gradually expands to the surrounding normal skin.
5. After simple surgical resection and suture treatment, it is easy to relapse, and the stronger the hyperplasia, the area is larger than the original scar, and the growth rate is faster. Therefore, it is not possible to remove it at will.
Keloids occur in the upper neck, ears, chest, shoulders and upper arms. The sternum of women is a good site for their hair, which is related to the weight of both breasts and respiratory movement.
At present, the cause of keloids is unknown, and may be related to the specific quality of individual human body, the so-called scar body. In addition, chronic infection and chemical stimulation are also a cause of pain. It is also related to family inheritance.
Superficial scar
This refers to a scar on the superficial layer of the skin, mostly caused by mild skin abrasions or superficial burns (shallow dermis), which is slightly different from normal skin, with rough surface or pigmentation, and generally no dysfunction. As time goes by, the scar will gradually become inconspicuous, so such scars generally do not need to be treated.
Atrophic scar
It is the most unstable scar tissue, also known as unstable scar. It is common in large-area burns, especially wounds in deep and fat layers. It can be healed by the growth of peripheral epithelial cells without skin grafting. In addition, chronic ulcers in the lower leg or other parts healed by long-term treatment, which is also a scar of this nature. The characteristics of this scar are: the scar is thin, the surface is flat, the local blood circulation is poor, the white is bright white and the base is hard. Because the surface layer only covers a layer of atrophic epithelial cells, it can not easily resist damage and form ulcers, which is generally difficult to heal, and can cause malignant transformation after a long time. Because such scars often adhere to the underlying muscles, nerves, and blood vessels, and have a large contractility, normal tissue can be pulled to cause or more severe dysfunction than proliferative scars.
Because this kind of scar is very destructive, it should be prevented. It should be implanted early and not allowed to heal itself.
Contracture scar
A contracture scar is a scar named after the dysfunction caused by it. More common after deep burn healing, due to scar contraction, often lead to shape changes and dysfunction, long-term scar contracture can affect the development of bones, muscles, blood vessels, nerves and other tissues, should be treated early. Clinically common deformities caused by scar contracture include valgus valgus, lip valgus, chest-thoracic adhesion, hand scar contracture deformity, and flexion or extension of the joints. Among them, the cord-like scar contracture in the flexion of the joint, for a long time, the skin and subcutaneous tissue on both sides of the contracture scar can gradually elongate, becoming a scar-like scar contracture, called a scar contracture scar. Such larger scars are common in the anterior neck, axillary fossa, elbow fossa, ankle joints, etc., and the smaller ones can be found in the medial malleolus, external malleolus, nasolabial fold, mouth, finger, etc. The opening of the body cavity is annular, causing its narrow diameter and affecting normal function. The wart-shaped contracture scar can be repaired by the principle of Z-plasty.
Depressed scar
When the scar tissue causes a concave deformity on the body surface, it is called a concave scar. Scars that are common in smallpox, chickenpox or acne can also be found in patients with trauma and skin infections. Simple depressed scars are only linear scars and depressions in their areas. Extensive concave scars can be combined with subcutaneous tissue, muscle or bone tissue defects. The scar base is stuck to the deep muscles or tendons. To correct this deformity, not only the scar on the skin, but also the different methods to repair the defect according to the degree of depression, to restore the normal shape.
Surgical scar
Surgery scars will be left after surgery, which is unavoidable. The choice of surgical incision will affect the surgical effect and will affect the shape and size of the surgical scar. Therefore, choosing the correct surgical incision during surgery will lay a good foundation for eliminating surgical scars in the future.
Scar cancer
Scar tissue can become malignant into scar cancer. Scar cancer occurs mostly in contracture scars caused by burns. It often occurs in the vicinity of the joint, because the scar is constantly pulled by the joint activity, repeated ulceration, adulthood, and eventually cancerous, scar cancer can also be found in the chronic ulcer of the lower extremity or the scar tissue of the chronic osseous sinus. Scar cancer is mostly a relatively differentiated squamous cell carcinoma. Lymphatic metastasis is the main cause, and blood transfer is rare.
Scar appearance classification
1. Depressed scar is mainly caused by acne, infection, trauma, surgery and other reasons. Heavier acne can be seen after the worm-like, ice cone-like concave sputum, smallpox, varicella can be seen after the pit.
2. Most of the prominent scars are proliferative lesions of fibroblasts in the dermis of the skin after burns, trauma, surgery or repeated infection. It can be seen that there is a red bulge, a hard texture, a smooth surface, and it can be accompanied by itching. The keloid can also expand outward like a crab foot. The convex scar has a rich blood supply and more than twice as many oxygen free radicals as normal skin and proliferating fibroblasts.
3, flat scar refers to a scar on the superficial layer of the skin, mostly due to mild skin abrasions or superficial (superficial dermis) burns. The surface is rough or has pigment changes (such as skin erythema, white spots or pigmentation), generally no dysfunction, but such scars affect visual aesthetics.
4, spontaneous keloid: no obvious cause, on the normal skin or not noticed by minor scratches, so that the skin appears induration gradually grow, the edge is irregular, extended to the periphery, forming a crab foot or braided, butterfly Shape, round, hard, pale red or dark red, consciously itchy, sometimes accompanied by paroxysmal pain or tingling.
5, secondary keloids: generally occur in skin burns, infections, trauma, trauma. Such as: doing freezing, laser, sputum, eyebrow washing, ear piercing, vaccination, surgical skin grafting, caesarean section and other scars caused by various operations, higher than skin red or dark red, itchy, thorny Pain, eating spicy food, alcohol and other foods, the symptoms worsened.
Scars are traces of the skin that have been traumatized. This type of trauma can be caused by trauma, or it may be necessary for surgery. It is only because of the degree of trauma, whether the healing process is smooth or not, and the position of the wound on the human body is different. The scars have obvious differences in size; especially with the progress of modern society, Amy not only represents a right, but also a kind of respect for self. Scar is the most common problem in cosmetic plastic surgery clinics. First, in addition to the appearance of the effect, in fact, there are many scars that will be uncomfortable itching, pain and chapped, if unfortunately scar contracture (scar contracture), will not affect the joint function of the limbs or the normal function of the five senses These scars are more than non-active treatment.
Examine
Scar inspection
Perform a skin test. Physical examination of skin diseases is a physical examination of the skin, such as skin scratch test, slide examination and so on. The appearance of the skin is observed, and the skin is non-destructive, and the non-lesional state is normal. Check the skin should be carried out under natural light. In addition to examining the exposed skin, the skin of the trunk and the mucous membrane of the mouth should be examined. It is necessary to have a comprehensive impression not only to be diagnosed but also to be diagnosed correctly.
Diagnosis
Scar diagnosis
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Depressed scar is mainly caused by acne, infection, trauma, surgery and other reasons. Heavier acne can be seen after the worm-like, ice cone-like concave sputum, smallpox, varicella can be seen after the pit.
2. Most of the prominent scars are proliferative lesions of fibroblasts in the dermis of the skin after burns, trauma, surgery or repeated infection. It can be seen that there is a red bulge, a hard texture, a smooth surface, and it can be accompanied by itching. The keloid can also expand outward like a crab foot. The convex scar has a rich blood supply and more than twice as many oxygen free radicals as normal skin and proliferating fibroblasts.
3, flat scar refers to a scar on the superficial layer of the skin, mostly due to mild skin abrasions or superficial (superficial dermis) burns. The surface is rough or has pigment changes (such as skin erythema, white spots or pigmentation), generally no dysfunction, but such scars affect visual aesthetics.
4, spontaneous keloid: no obvious cause, on the normal skin or not noticed by minor scratches, so that the skin appears induration gradually grow, the edge is irregular, extended to the periphery, forming a crab foot or braided, butterfly Shape, round, hard, pale red or dark red, consciously itchy, sometimes accompanied by paroxysmal pain or tingling.
5, secondary keloids: generally occur in skin burns, infections, trauma, trauma. Such as: doing freezing, laser, sputum, eyebrow washing, ear piercing, vaccination, surgical skin grafting, caesarean section and other scars caused by various operations, higher than skin red or dark red, itchy, thorny Pain, eating spicy food, alcohol and other foods, the symptoms worsened.
