In life, when encountering problems, facing or avoiding, you will be anxious and confused;
The purpose of the scar is to repair, repair, and repair, and it is a very tenacious "warrior" who does not hesitate to hyperemia, swelling, collagen deposition, tissue proliferation, and then finally closes the wound in order to repair the wound.
The body with scars is not beautiful, and after solving the problem of survival, the unbeautiful will be disliked, so people gradually put the scar on their opposite side, fight, confront and exterminate it.
But, is this really true? From the perspective of plastic surgery, I have come into contact with many patients and beauty seekers, and I have learned a lot and thought about it. Walking with scars, I would like to share a little bit of my experience at the beginning of 2022.
Injuries are inevitable in life, and the scar itself is a trace of life.
I wanted to write this paragraph as: The epidemiology of scarring. However, it is really difficult to make demographic statistics on the distribution of scars by age and sex, and at most they can be distinguished by race and ethnicity. Human life is accompanied by constant activity, and any wounds need to be repaired to ensure the continued survival of living beings. We already know that ** is the largest organ of the human body, there is epidermis, dermis, subdermal and other differentiation, in addition to the epidermal wound can be healed by epithelial crawling, leaving no appearance and functional disorders, the accumulation of dermis and lower trauma will inevitably cause a large number of deep fibrin breakage, as well as extracellular matrix damage, repair process, fibrin resynthesis, arranged in a certain order and proportion, mixed with orderly extracellular matrix, there is a foreign name called ECM, But this process is too delicate, and a slight carelessness will form a chaotic organizational structure, that is, scarring, not a perfect replacement, appearance, texture, and structure are chaotic. The scar is like an emergency band-aid, which is randomly filled in the wound to ensure isolation from the outside world, has a certain mechanical strength, and some of the recovered ones can even grow hair follicles, sensory bodies and other appendages.
Knowing that human species and ethnicity provide independent factors for the risk of scarring, we don't like to hear that "Asians are more susceptible to hypertrophic scars than Caucasians; The incidence of scarring and keloids in people of color was statistically different from that of Caucasians.
Usually in epidemiology, we use the concepts of genetics and environmental influences. Ethnically, we may have differential gene expression, and ethnicity is related to a certain environment, and the poisonous sun in the Indian subcontinent can change the white skin of Aryans, and also give Indians a different incidence of scarring than Aryans. It is precisely because of this that our interpretation of the "Scar ** Opinions" in Europe and the United States needs to be viewed dialectically, fortunately, China put forward the "Expert Consensus on Clinical Scar Prevention and Control in China" in 2017.
Scars are different from scars and are classified and clinically classified
The chaotic formation of scars, but not the paste, is the same as we often understand fracture healing, there is an early congestive, inflammatory process, followed by organic filling, this stage is called the immature stage, that is, the early stage within 3 months, and then the scar formation is slowly mature.
If you want the scar to recover closer to the original, early intervention and protection are very important, because at that time it looks red, there are many savage growth capillaries, reticular rich capillaries, we call it "congested scar".
"congestion" is a relatively vernacular term, and "capillary hyperplasia" may be a term that medical students can better understand. In any case, vascular proliferation gives a large local input of nutrients and oxygen, and local hypermetabolism usually makes you feel a slight increase in epithelial temperature, while local fibroblasts synthesize collagen and secrete a large amount of ECM, which cross-links with each other to form a fresh immature scar like "chaotic early opening"; "Congestion" is a state and a process, and since it is a process, it enters the maturity period in 6-12 months. During this short period of time, the pathophysiology of scarring continues to occur. At the cellular level, fibroblasts (mentioned earlier), myofibroblasts, mast cells and neutrophils all obtain proliferation and physiological activation through hypermetabolism. Our common perception is that the transformation growth factor TGF-, tumor necrosis factor TNF-, vascular endothelial growth factor VGF, etc. continue to intervene in the above cells, and then adjust the production capacity of collagen metabolism and glycosaminoglycan synthesis, and modify the three-dimensional structure of the ECM of the extracellular matrix, and even make the distribution of core cells such as fibroblasts in the region lose their original sequencesKeloids and keloid carcinoma, which will be mentioned later, are associated with this factor.
The scar itself is an emergency repair process, and various factors lead to the imperfection of this repair, and the imperfect differences are reflected in the anatomical observation, which are classified according to these differences at home and abroad.
The difference in color, texture, and feeling is also the difference in the stage of growth. On the timeline, it is divided into: immature scars and mature scars. The texture is usually soft at first, and as the collagen continues to restructure and mature, the texture slowly becomes hard, just like a boy grows into a man and a warrior, (sorry, I don't have the idea of sexism, but in the erection of the line, men are more labeled); Accompanied by capillary hyperplasia, most of them will turn white when pressing, and turn red when they release compression, which can be called "regurgitation" in professional academic terms. Half a year to a year later, or even longer, the scar gradually matures, the color becomes similar to the surrounding **, and the inflammatory dilated blood vessels gradually become orderly, in line with our reconstructed blood vessels in flap surgery in line with the phenomenon of "least blood vessels, maximum innervation", although the total amount of blood vessels is reduced, and the surface is not so red, but in the scar removal operation, you will still find that there are still a lot more small blood vessels than normal tissues.
According to the different anatomical morphology, including macroscopic macroscopic observation and microscopic microscopic section, in mature scars, they are divided into: hypertrophic scars, keloids, atrophic scars and keloid carcinomas. Yes, we mentioned that this is not very common, but it has to be diagnosed with increased vigilance in the reception.
"Hyperplasia" is the most desired phenomenon in repair and reconstruction, but it is also the most troublesome phenomenon that is not easy to intervene. Once it begins to proliferate, it means that the tissue has passed the stages of early necrosis, poor activity, infection, chemical burns, etc., and has thoroughly cleaned up the "bad assets" and began to regain lost ground, so high-quality cells grow in large quantities, secreting collagen, glycans and other structural components of ECM, just like building a house, piling and laying the foundation work is carried out quickly, on this basis, collagen reconstruction and recovery sequence is a delicate work, so we often cry and laugh at hypertrophic scars and keloids. If the scar has a gender, it must be more male, why, it looks too casual, if there is a little bit of "ancient women learn embroidery" foundation, or modern girls play "cross-stitch", it will not grow like this!
Because the growth is too casual, the proportion of collagen is too high, the elasticity is poor, and it is easy to itch when rubbed by clothing, and there will be ulcers if scratched.
One of the factors mentioned above is wrapped in "stem cells", which leads to the expansion of the scar to the normal tissue after filling the wound, and there is a professional "crab foot" growth, and the shameless enclosure without a bottom line is called keloid, which is even more difficult to deal with, and keloids with tumor characteristics are generally recommended to be surgically excised in combination with other techniques;
The cause of atrophic scar is a little different from the first two, mostly due to the relatively negative hyperplasia, and the "immature" stage is hastily ended in the state of insufficient collagen fiber filling, just like the child labor in the factory, and it has not yet grown up to assume social responsibility, and therefore, it is manifested as a depression on the **, and the essence is the lack of collagen fibers and subcutaneous fiber contracture. It is very interesting that this "child labor" prone group is teenagers, and most of them appear when pimples, that is, "acne" is combined with infection and trauma.
Scar cancer is an uncomfortable-looking diagnosis, but it is not tumor-like as soon as it appears, and it is more common in more than ten or twenty years of "stocking", growing freely, constantly hurting, constantly repairing itself, and then going down the wrong path. Sound familiar? There is a similar concept in psychology called "unhappy childhood". Don't blame it for growing into a tumor, you missed attention and intervention during your childhood, and it went astray. It has a somewhat aggressive malignancy, also known as Marjolin s ulcer. Burns are the most common clinical cause of keloid cancer.
Conclusion:
There is really no sudden bad luck, some reasons can be found in the trivial, whether it is hypertrophic scars, keloids, keloid cancer, it is not an overnight bad luck, except for the really rare "scar constitution", many of them are caused by improper treatment or lack of attention in the early stage, if you pay attention to it strategically and target it tactically, it may stop before pathological scarring.