scarring
Introduction
Introduction The formation of scars is caused by the body's inflammatory response, imbalance of collagen synthesis and degradation, the appearance of abnormal mucopolysaccharides, and the proliferation of fibroblasts. Reduced lymphatic drainage in hypertrophic scars, local edema, can lead to hypertrophy of scars, is an inevitable outcome of the body's wound repair.
Cause
Cause
When the body tissues, especially the skin tissues, are damaged to a certain depth, the wounds first appear to have an inflammatory reaction, and white blood cells, macrophages, mast cells, etc. infiltrate, releasing a variety of cytokines (growth factors), fibroblasts and myofibroblasts. A large number of hyperplasia and synthesis of a large amount of collagen and matrix, resulting in collagen metabolism and alignment abnormalities, abnormal matrix deposition, coupled with microcirculation and free radical factors, promoted the formation of scars.
Examine
an examination
Related inspection
Skin fungal microscopy
In clinical patients who have seen scar formation, we must first see whether there is a history of trauma, history of infection, history of surgery, diagnosis based on clinical symptoms and signs; second, physical examination, according to the characteristics of scar formation, identify the depression Scars, superficial scars, scar atrophy, scar hyperplasia; laboratory examination if necessary to determine the cause and severity of scar hyperplasia, to provide a basis for further treatment.
Diagnosis
Differential diagnosis
Differential diagnosis of scar formation:
Unstable scar: refers to the early healing of the wound, and the scar tissue is mostly in the proliferative stage. Clinically, the scar is higher than the leather surface, the color is red, the quality is hard, often itching, the scar tissue is congested, it is easy to blisters, and the wound is getting worse and worse. This process usually takes 6 months to a year.
Stable scar: After the wound has healed for half a year, the scar tissue gradually matures, the components of fibroblasts and capillaries gradually decrease, and the collagen fibers are arranged in a ring-like nodule, forming a parallel bundle. At this time, the scar tissue in the clinical area disappeared, the color became lighter, the shape became flatter, the texture became softer, the base became softer, and the itching felt relieved or relieved. This kind of degenerative change can vary from a few months to several years.
(1) superficial scar: more common after bruising and shallow burns, characterized by a slightly rough appearance, pigmentation changes, local flat and soft, no dysfunction, generally do not need to be treated.
(2) hypertrophic scar: also known as hypertrophic scar, more common in deep second and shallow third degree burns and thick medium thick skin donor site wound healing. It is thick (up to 1-2 cm) and hard, red or dark purple, painful and itchy, often affecting work and rest. About 6 months later, the scar became softer and slightly flatter, the congestion decreased, the capillaries decreased, and the symptoms of itching gradually diminished or disappeared.
(3) atrophic scar: also known as unstable scar, common in the head skull electric shock, after extensive burns and chronic ulcer healing. The scar is hard, the local blood vessels are less, it is reddish or white, the deep tissue is tightly adhered, and it cannot withstand friction and weight. After rupture, it often lasts for a long time, and the late stage can cause malignant changes.
(4) contracture scar: more common in deep burn wounds without skin grafting and let them self-healing, often severely disrupting functions, such as valgus valgus, lip valgus, chest adhesions, flexion contracture deformity of each joint. Long-term scar contracture can affect the development of muscles, tendons, and nerves, causing joint stiffness, dislocation, and deformity.
(5) keloid: also known as the crab foot swelling, a mass formed by connective tissue. More common in burns, injuries or minor injuries that do not cause the patient's attention. The edge of the scar is significantly higher than the skin, and exceeds the original lesion range, pink or purple, very hard, inelastic, poor blood supply. Keloids are particularly good in the upper part of the body. The head, neck, and sternum are in the middle, shoulders, and upper arms, and the eyelids, areola, and penis are rare.
(6) Scars: The scars are wrinkled and shaped like duck plague. Such scars are most common in burns, occasionally in the cutting tears of the skin and improper placement of surgical incisions. Large blemishes often occur in the anterior neck, axillary fossa, elbow fossa and perineum. Small ones are common in internal and external spasm, nasolabial folds, mouth, nostrils, palmar side, finger sputum, tiger's mouth, urethral opening, vaginal opening and other parts.
In addition, there are still types of depressed scars, bridge scars and linear scars.
