User talk:Osotex

HYPERTROPHIC SCARS / KELOIDS-CAUSE
The reason scar tissue hypertrophies or forms keloid is simply a lack of order. In normal skin new collagen, which is continually laid down, is deposited by fibroblasts which move through the tissue on previously erected strands of collagen or elastin. Fibroblasts producing collagen trail new fibrils behind themselves as they move through the tissue. Contractile bundles within the cells both facilitate cellular movement and also pull the new collagen fibrils taunt. Thus in normal tissue the newer collagen is constructed along previously fabricated fibers. This ordered array of fibrils and fibers in the skin produces the tensile forces called 'Langers Lines' in the integument. Abnormal scar formations are simply a result of the loss of fiber order, as caused by a severe second or third degree burns or an excisional injury, to the dermis. Ordered arrays are not present in the epidermis, which has been lost, or the hypodermis which may or may not remain. Wound healing fibroblasts move into these severe wounds from their margins. The cells begin to reestablish order in the wound areas by producing new collagen fibrils and fibers. Initially the cells migrate through the tissue on fibrin strands produced by the blood coagulum which fills the wound void. As the fibrin lacks any degree of order the resultant collagen fibrils and/or fibers tend to ball up into amorphous deposits eventually covered by epidermis either by graft or marginal growth. Lacking any order, the new collagen and cells cannot stanch the blood supply into the tissue as it grows. In normal repairing wounds healed by secondary intention, for instance, the new wound repair tissues contract and thus causes the network of collagen and cells to constrict the underlying blood vessels much like a chinese finger torture. The more it pulls, the tighter it becomes.... Hypertrophic scar and keloid nodules are not interconnected so they grow and grown until their mass eventually produces overlying pressure forces in the hyperdermis that suppresses blood flow and thus signals the end to synthesis. It is only after the cessation of collagen synthesis that the fibroblasts can begin to remodel the scars by changing into fibroclasts and resorbing the amorphous collagen. This process, as one might expect is of long duration...The way to prevent hypertrophic scars is to graft DERMIS on to the full thickness wound and not epidermis only. If this is read by a physician, the use of the 'second plow' graft onto the wound would be most useful. Second plow would provide epidermal cells and the ordered arrays of collagen fibers needed to re-establish order in the healing integument.