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Scarless Wound Healing

June 13, 2000

Complete Document

Detail Summary

Active, Most Current

Additional Comments:
ISBN: 978-0-203-90965-2
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Product Details:

  • Revision: June 13, 2000
  • Published Date: June 13, 2000
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 345
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


The significance of the concept of scarless healing is one which takes some insight to fully appreciate. Scarring is the consequence of a complex series of physico-chemical processes whereby a discontinuity in connective tissue integrity— a wound—heals. Postnatal healing involves a rapid but random deposition of structural elements to rebuild the tissue defect. The organization of this repair tissue, however, never achieves the high level of complexity exhibited by the cellular and matrix elements in the surrounding normal tissue. Nowhere is this more apparent than in human skin and, in particular, when skin has been extensively damaged as in a major burn. The deformity, the disability, and the despair that result from these injuries even today are a salutary reminder of where we are in the state of our practical understanding and control of clinical wound healing.The skin is a highly elaborate structure that serves many functions, from protection through perception, and through complex physiological roles. The skin is the great interface between the self and the outer world. It is far more than just a physical construct, it is a highly complex physio-socio-biological construct. We begin to think in terms of perfection when we consider the softness and beauty of human skin.

The skin is the largest and most visible organ in the body and is endowed with many subtle properties. Scarless healing in the skin is a subject of intense investigation in both academic and commercial research departments. Excellent progress has been made in wound healing but it is not currently possible to prevent repair defects. This book provides an inspiring overview from authors who look at specific aspects of cell and matrix interactions. They give a very personal insight into the state of development in research in this fundamental area of biomedical investigation.

The 15 chapters in this book present a sequence leading from the alterations in the composition and organization of the matrix in the scar tissues following postnatal injury, through the role of different macromolecules in wound repair, recent advances in embryonic wound healing, and characteristics of fetal wound repair, and, finally, to artificial covering materials for wounds.

The first chapter, by Garg, Warren, and Siebert, focuses on the chemistry of scarring. Changes in the amounts, distribution, and composition of proteoglycans in different types of scars that develop in adult wound healing are discussed. The rapid progress in this area has provided significant information about the formation of normal, hypertrophic or keloid scars. It has been found that the sulfonation of proteoglycans increases in different scars to different degrees and that chlorate ions eliminate sulfation to various degrees depending on the concentration of chlorate ions. In Chapter 2 Silbert describes modification of proteoglycan sulfonation as a potential remedy for scarring.

The repair of injury is orchestrated by insoluble and soluble effectors. In Chapter 3 Gallo, Kainulainen, and Bernfield discuss the evidence demonstrating that syndecans may control the wound repair process. The integrin family has emerged as a critical player, as it is involved in all phases of repair after an injury. Integrins act as structural molecules important in cell adhesion, function, and signal processing. In Chapter 4 Xu and Clark address the issue of integrin regulation in tissue repair.

Collagen is the major component of skin, and a considerable amount of research has been done to establish a relationship between disorganization of collagen in scars and changes in the composition of types of collagen. In Chapter 5 Ehrlich reviews the collagen considerations in scarring and regenerative repair.

Hyaluronan increases immediately after an injury and returns to normal levels after about three weeks. The molecular weight of hyaluronan present in the early stages of the repair process appears to determine the type of scarring formed after healing. In Chapter 6 Savani, Bagli, Harrison, and Turley review the role of hyaluronan/receptor interactions in wound repair. In Chapter 7 Balazs and Larsen focus on developments involving hyaluronan that are aimed toward perfect skin generation.

In order to understand defects in the repair process after an injury, it is important to know the molecular and cellular biology of fibroproliferative disorders. In Chapter 8 Kim, Levinson, Gittes, and Longaker present the molecular mechanisms involving keloid biology. In Chapter 9 Bauer, Tredget, Scott, and Ghahary summarize the molecular and cellular biology of dermal fibroproliferative disorders.

In comparison to postnatal wound healing, early-gestation fetal wounds heal without any defect, but what is the importance of this for people? Research in this area has provided insights for adult wound healing with minimal defects. Transforming growth factor beta 1,2 has been detected only in neonatal and adult wounds, not in fetal wounds. In Chapter 10 Shah, Rorison, and Ferguson describe the role of transforming growth factors β in cutaneous scarring. In Chapter 11 Shaw discusses recent advances in the study of embryonic wound healing. In Chapter 12 Chin, Stelnicki, Gittes, and Longaker summarize the characteristics of fetal wound healing.

In order to avoid outside infection during the healing process, temporary covering of the wound is important. Several materials have been developed to cover the wound area. In Chapter 13 Yannas gives facts about and models of induced organ regeneration in skin and peripheral nerves. In Chapter 14 Orgill, Park, and Demling review clinical use of skin substitutes. Finally, in Chapter 15, Burns and Barry describe the usefulness of hyaluronan-based membrane for the prevention of postsurgical adhesions.

In summary, this book presents significant information in the field of wound healing with its ultimate goal of scarless healing and also discusses the limitations of the research done in this area.

The information in this book provides an overview for all surgeons, particularly plastic surgeons, and dermatologists concerning developments in the wound repair process aimed toward scarless healing, which is the ultimate goal. It also delivers to medical students and nonspecialist researchers in the area of wound healing up-to-date information on scarless repair.