what are stable and unstable scars?
unstable scar: refers to the early stage of wound healing, and scar tissue is mostly in the proliferation stage. Clinically, the scar is higher than the skin surface, flushed in color, hard in texture, often painful, the scar tissue is congested, easy to blister, and the wound surface is getting worse and worse. This process often takes about 6 months to a year.
stable scar: after the wound healed for half a year, the scar tissue gradually became mature, the components of fibroblasts and capillaries gradually decreased, and the collagen fibers were arranged like annual rings and became parallel bundles. At this time, the clinical scar tissue congestion subsided, the color faded, the appearance became smoother, the texture became softer, the base became softer, and the itching feeling was alleviated or relieved. This kind of degeneration takes several months to several years.
what factors affect scar hyperplasia?
(1) Skin tension and location: human skin has tension relaxation line (RSTL). Where the incision is parallel to RSTL, the tension is low; However, when perpendicular to RSTL, the tension is high, which is easy to cause fiber proliferation. It has been proved that the scar width perpendicular to RSTL is twice that of the incision parallel to this line. Incision should be made according to dermatoglyphics or skin tension lines during operation to reduce the formation of hypertrophic scars.
Different parts of the body have different skin tension. The chin, anterior sternum, deltoid muscle, upper back, elbow, hip, knee, ankle and instep, etc., have high skin tension and many activities, which are the places where scars are prone to occur. On the contrary, eyelid, forehead, waist, forearm, calf, external genitalia, areola and other parts have low skin tension, light scar and low incidence.
(2) Age: Keloid is a disease of young people, but not common in the elderly. Mainly because teenagers are in puberty, tissue grows vigorously, post-traumatic reactivity is strong, skin tension is high, and scar hyperplasia tends to occur easily. And the skin of the elderly is slack, the tension is small, and the collagen fibers are pulled back? History [5]? Shi ting? br> (3) Skin pigment: It is closely related to keloid.
(4) Infection: Acute and chronic infections have scar hyperplasia in different procedures after healing.
(5) Foreign bodies on the wound surface: dust, talcum powder and knots can stimulate scar hyperplasia.
how many types of scars are there? What are the characteristics of each type?
(1) Superficial scar: It is more common after abrasions and superficial burns, characterized by a slightly rough appearance, pigment changes, flat and soft parts, no dysfunction, and generally does not need to be treated.
(2) Hypertrophic scar: also known as hypertrophic scar, it is more common in deep second-degree and shallow third-degree burns and after the wounds in the donor area of thick and medium-thickness skin graft heal themselves. Characterized by thick (up to 1-2 cm) and hard, red or dark purple, painful and itchy, often affecting work and rest. After about 6 months, the scar gradually became soft and slightly flat, congestion decreased, capillaries decreased, and itching and pain symptoms gradually eased or disappeared.
(3) Atrophic scar: also known as unstable scar, it is common after electric injury to the head and skull, extensive burns and healing of chronic ulcers. Scar is hard, local blood vessels are few, reddish or white, and deep tissues are closely adhered, so it cannot tolerate friction and load. After rupture, it often lasts for a long time and can lead to malignant transformation in the later stage.
(4) Contraction scar: It is more common in deep burn wounds that are left to heal by themselves without skin grafting, which often severely damages their functions, such as ectropion of eyelid, ectropion of lip, adhesion of chin and chest, and 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 crab's foot swelling, which is a mass in connectivetissue. It is more common after burns, injuries or minor injuries that do not attract the attention of patients. Scar edge is obviously higher than the skin, and beyond the original lesion range, pink or purple, extremely hard, inelastic, poor blood supply. Keloid is particularly common in the upper part of the body. Head, neck, median sternum, shoulder and upper arm are the most common parts, while eyelids, areola and penis are rare.
(6) webbed scar: the scar is wrinkled and looks like a duck web. This kind of scar is most common in burns, and occasionally in skin cutting and tearing and improper surgical incision position. Large webbed scars are mostly found in the front of neck, armpit, elbow fossa and perineum, while small ones are common in inner and outer canthus, nasolabial groove, mouth corner, nostril, palm of finger, webbed fingers, tiger's mouth, urethral orifice and vaginal orifice.
In addition, there are concave scars, bridge scars and linear scars.
will the scar become cancerous?
Unstable scar, especially when the scar is broken for a long time, often leads to ulcer malignant transformation in the late stage. This malignant ulcer is also called Marjolin ulcer. It was named after Marjolin, a French surgeon, discovered in 1928 that old burn scars could be ulcerative and malignant.
(1) onset age: 12-72 years old in foreign countries and 21-64 years old in China.
(2) time of onset: short-term patients only have 3 months after burn, and some patients have onset for more than 6 years, with an average of about 32 years.
(3) Common site: it is common in lower limbs, and occasionally occurs in other parts. On the basis of radiation ulcer, the incidence of canceration is high.
(4) prevention: unstable scars get worse and worse, especially ulcers that persist for a long time, which is often a sign of malignancy. Scar should be removed together with ulcer (the removed tissue should be sent for pathological examination), and skin grafting or skin flap transfer should be used to repair the wound. This is the best measure to prevent malignant transformation.