What Causes Muscle Scar Tissue?

Scar is a collective name for the appearance, morphology, and histopathology of normal skin tissue caused by various traumas. It is an inevitable product of the human wound healing process. When the growth of scars exceeds a certain limit, various complications, such as damage to appearance and functional dysfunction, will bring huge physical and mental pain to patients, especially scars left after burns, burns, and severe trauma.

Basic Information

nickname

scar

English name

scar

Visiting department

surgical

Multiple groups

Scar physique

Common causes

Caused by skin trauma, cuts, burns, infections, etc.

Common symptoms

Scars are protrusions different from normal skin, rough and pigmented

Cause of scar

Human skin damage is the cause of scar formation, including skin trauma, cut wounds, burns, skin infections, and surgery.

Keloid

Keloids are a special type of skin scar. Systemic factors may play a major role, especially specific physical fitness factors, which sometimes show genetic characteristics. It is a benign tumor-like reaction caused by excessive tissue proliferation after skin injury. Scar patients often have a scar physique and are prone to occur in people of color. The causes are wound infections, foreign bodies, burns, and certain inflammatory skin diseases such as acne, folliculitis, and suppurative sweat glanditis. Most keloids usually occur within one year of local injury, including surgery, lacerations, tattoos, burns, injections, animal bites, vaccination, acne and foreign body reactions. Keloids in these patients often have no obvious relationship with the severity of skin damage, and even minor trauma, such as mosquito bites, vaccination and other needle stick injuries can form keloids.

2. Hypertrophic scar

It is a slight hyperplasia of connective tissue after skin injury, and scar tissue rises slightly from the skin. It is usually caused by poor alignment during trauma suture, excessive skin treatment, deep skin abrasions, acne and other reasons.

3. Atrophic scar

Caused by poor repair of connective tissue after skin injury. The causes of scars are mostly caused by radiation treatment, isotope application, and burns.

Clinical manifestations of scars

Superficial scar

Generally involves the epidermis or superficial dermis, the surface of the skin is rough or there are pigment changes, the area is flat and soft, and there is generally no dysfunction. Over time, the scar will gradually become inconspicuous.

2. Hypertrophic scar

After trauma or local treatment (such as laser, electrocautery, and chemical burns), the injury involves the deep layer of the dermis, the scar is significantly higher than the surrounding normal skin, and the local thickening becomes hard. Lesions usually do not extend beyond the area of injury. In the early days due to capillary congestion, the scar surface was red, flushed, or purple. During this period, itching and pain are the main symptoms with mild tenderness. Even the surface was broken due to scratching. Symptoms may worsen when the ambient temperature increases, the emotions are agitated, or when spicy food is stimulated. Hypertrophic scars often last for months or years before they gradually degenerate. The congestion is reduced, the surface color becomes lighter, the scars become softer and flatter, and the itching pain is reduced to disappear. The length of this proliferative period varies depending on the person and the lesion. Generally speaking, the proliferative period is longer in children and young adults, while the proliferative period is shorter in the elderly over 50 years old; it occurs in rich blood supply, such as facial scars, and it occurs in poor blood supply, such as limbs The hypertrophic period of the scar at the end and the anterior tibial region is short. Although hypertrophic scars can sometimes be more than 2 cm thick, they are not tightly attached to deep tissues and can be pushed. They generally have a clearer boundary with the surrounding normal skin. Hypertrophic scars are less contractile than contracture scars. Therefore, hypertrophic scars that occur in non-functional sites generally do not cause serious dysfunction, and large hypertrophic scars in joint sites, because of their thick splint, hinder joint activity and can cause dysfunction. Hypertrophic scars located on the flexion surface of the joint can contract more obviously in the later stage, which can cause obvious dysfunction such as jaw and neck adhesion.

3. Atrophic scar

Generally, the damage is severe, involving the entire layer of skin and subcutaneous adipose tissue. Clinical manifestations: the local tissue is thin, the scar is hard, flat or slightly higher than the skin surface, and it is tightly adhered to deep tissues such as muscles, tendons and nerves. The local blood circulation of the scar is very poor, it is light red or white, the surface is pigmented or variegated, and the epidermis is extremely thin and inelastic. If the ulceration occurs over a long period of time, malignant transformation may occur in the advanced stage, and most of them are squamous cell carcinoma. Atrophic scars have great contractility and can pull adjacent tissues and organs, causing severe dysfunction.

4. Keloid

Generally, it is a persistently growing mass that is higher than the surrounding normal skin and beyond the original injury site. It is relatively hard, with poor elasticity, local itching or pain, and sometimes itching and tenderness. The early surface is pink or purple. The quality is like rubber, which can increase quickly after scratching. Most of the later period was pale and hard. Sometimes there is hyperpigmentation, which has a clearer boundary with the surrounding normal skin. Lesions range in size from 2 to 3 mm papillary to palm-like pieces. Its morphology is diverse. It can be relatively flat, symmetrical protrusions with regular edges, or uneven, uneven bumps with irregular protrusions. Sometimes they infiltrate into the surrounding tissue like crab feet (and Called "crab foot swelling"). Its surface is atrophic, but the epidermis of the keloid in the ear lobe can approach normal skin. Most cases are single and few cases are multiple. Keloids develop rapidly in the weeks or months after injury, and they can grow continuously and continuously, or they can be stable for a considerable period of time. In the lesion, inflammatory necrosis may occur due to the remaining hair follicle glands, or liquefaction necrosis due to central ischemia. Keloids generally do not cause contractures, and generally do not cause dysfunction except for a few joint sites that cause mild movement restriction.

Scar diagnosis

It can be diagnosed based on clinical skin damage without identification.

Scar treatment

Keloids in scars can be treated with injection therapy, laser treatment, surgery, radiotherapy or isotope application. Hypertrophic scars can be laser-ground, micro-crystalline, lattice laser-ground, anti-scarring products or ointments. Atrophic scars can be treated with microcrystalline grinding, multi-wavelength pulse therapy, and lattice laser grinding.

Non-surgical treatment

(1 ) Pressure Therapy uses a special pressure sleeve to apply pressure, which is suitable for people with large scar areas, which are not suitable for radiotherapy and local drug treatment. The daily deactivation time shall not exceed 30 minutes. This method has no obvious effect on active keloids, but it can reduce the postoperative radiotherapy and injection dose.

(2 ) Chemotherapy The long-acting steroid preparation is directly injected into the scar to inhibit the excess collagen in the scar and achieve the effect of degenerative scar. The main side effects are skin atrophy, discoloration, telangiectasia, necrosis, ulcers, and Cushing-like syndrome, and most of them are reversible. Other chemical drugs such as cytotoxins and immunosuppressive drugs have been reported, but serious systemic side effects have limited their application.

(3 ) Radiotherapy The use of electron beam or X-ray irradiation in the early stage (within 24 hours) of keloid resection can reduce the postoperative recurrence of keloid and improve the cure rate. Due to the special nature of radiation, it can increase the incidence of malignant tumors, so it is emphasized for the late stage of keloids and used when other methods are not effective.

(4 ) Laser treatment is suitable for flat scars without obvious dysfunction, and depressions of varying sizes and unevenness left over after the healing of smallpox, chickenpox and acne. Use nd, yag or co ₂ lasers to vaporize scar tissue to eliminate scars and abnormal skin pigmentation on scars.

(5 ) Others, such as cryotherapy, wax therapy, iontophoresis, ultrasound, etc., have different effects on the treatment of hypertrophic scars and keloids, lacking a large number of case control and follow-up.

2. Surgical treatment

(1 ) Reduced fine suture after scar resection is a well-established surgical method commonly used in the treatment of scars, and it is mostly applied to scars with a small area. In surgery, the clinical effect is clearly determined by fully reducing the tension of the incision, fine manipulation, reducing secondary injuries, and reducing the degree of scar hyperplasia after surgery.

(2 ) Skin grinding is a surgical method for grinding the epidermis and superficial dermis of skin to improve irregular parts of the skin surface, make it smooth and flat, and approximate the color. Adapt to acne, smallpox, chickenpox, shingles, eczema, trauma, burns or superficial scars left after surgery. If necessary, it can be performed at the same time as surgical removal of the scar, and the effect is better than that of simple grinding.

(3 ) Local reshaping of scar release The scars can be removed from small cable-like and webbed scars with tension, and then the surrounding normal skin tissue can be used to form flaps, and cross- replacement can be used to repair skin defects at the scar site. .

(4 ) Scar excision and free skin grafting Larger hypertrophic scars can be surgically removed, and then free skins are cut from normal parts of the body and transplanted to scar wounds to repair the wounds and restore skin function. However, the color of the transplanted skin is often significantly different from that of the surrounding skin. In addition, contracture is prone to occur after surgery. It is a disadvantage to pull the surrounding tissues and organs to deform or cause dysfunction.

(5 ) Scar resection flap transplantation Because the flap contains more subcutaneous adipose tissue, in addition to being used to repair skin defects after scar resection, it also has the effect of protecting deep tissues. At present, the commonly used dilator technology also belongs to flap transplantation. By embedding the dilator under the normal skin around the scar, after several months of expansion, the extra skin can be "grown" to repair the scar.

Scar prevention

1. Strict aseptic technique for wounds, to minimize the second trauma of the wound as much as possible, and promote early healing of the wound. Wounds healed under aseptic conditions can make scars occur to a minimum.

2. Pay attention to the suture of skin wounds, and the wound edges should be accurately matched. Sutures must be performed without tension to obtain better results. Otherwise, even if the wounds heal smoothly, wide and thick scar tissue will gradually be produced in the future.

3. Pay attention to the direction of skin surgical incision. Skin surgical incisions should be made along the direction of the skin lines. Linear incisions in joints and functional areas should be avoided as much as possible. Otherwise, heavier scars and varying degrees of contracture and dysfunction will occur.

4. When dealing with deep burns, properly treat the wound to prevent or effectively control the infection and promote early healing of the wound. Skin grafts were performed as early as possible on III ° burn wounds.

5. In the process of handling any wound, if you can pay attention to careful operation, avoid unnecessary surgical trauma, completely stop bleeding, apply delicate instruments and materials, and remove sutures early, the wound is often less after healing. To produce scar tissue.

6. Wounds in special parts, such as limbs, between the toes, armpits, and neck wounds, must be separated with oil gauze and other dressings to prevent adhesions from affecting function.