The mechanisms underlying the scar formation of Group 1

In response to trauma with damage to the vasculature, the skin develops an inflammatory process, which is a natural protective reaction of the body. The purpose of the inflammatory reaction is to remove fragments of the destroyed skin and, ultimately, to close the skin defect with a newly formed tissue in order to maintain homeostasis. Inflammatory reaction in this case is adequate, which leads to the formation of a different type of group number 1 ..

The processes aimed at maintaining the body's homeostasis through wound healing begin within the first 24 hours after the injury, but reach its peak no earlier than the 5th day.

The first reaction of tissues in response to damage is accompanied by vasodilatation, leukocyte diapedesis, which together with macrophages of the dermis cleans the wound from the cellular detritus, after which the next stage of the wound process - the collagen synthesis phase - begins. Collagen production is one of the most important moments in wound healing, since collagen fibers are replaced by a deep wound defect. The scar is, in fact, a "patch" of close-packed collagen fibers. Synthesis of collagen depends not only on the functional activity of fibroblasts, but also on the state of the wound, the biochemical processes taking place in it, the microelement composition of tissues, the general state of the macroorganism. So the deficiency of ascorbic acid, which serves as a cofactor in the hydroxylation of proline to the state of hydroxyproline, can lead to a deficiency of collagen and a prolongation of the process of scar formation. The successful hydroxylation of proline residues is impossible without iron diktat.

After the 7th day, the synthesis of collagen in the wound, where the process of physiological inflammation goes, gradually decreases. At this stage of physiological healing, it can be said that the reconstruction of the wound depends on the balance between the formation of collagen and its degradation, since for normal wound healing, collagen should not only be synthesized but also destroyed. The degradation of collagen is triggered by highly specialized enzymes. Called tissue collagenases, synthesized by macrophages, leukocytes, fibroblasts and epithelial cells. The activity of collagenase is impossible without sufficient concentration in the tissues of potassium and magnesium. A very important element in wound healing is zinc. Zinc deficiency is accompanied by dysfunctions of the endocrine system and a decrease in local and general immunity. Without sufficient zinc in the wound, epithelialization is difficult. An important factor for wound healing is the supply of tissues with oxygen, since hypoxia causes excessive fibrogenesis, which adversely affects the relief of the scar.

However, scar tissue consists not only of collagen fibers, but also of cellular elements, which are its main active elements. Cells are interconnected through cytokines such as platelet growth factor, transforming betta growth factor, the main fibroblast growth factor, epidermal growth factor, etc. Thanks to the cellular interaction in the wound, a sequence of processes leading to elimination of the defect in the skin is carried out.

The intercellular substance also plays an important role, since it facilitates intercellular interaction, the movement of cells and cytokines in the wound and the exchange of information. Accordingly, a shortage of glycosaminoglycans will help delay the process of wound cleansing and scar formation.

Thus, we see that cellular regeneration and hyperplasia of connective tissue components of the dermis with the goal of maintaining homeostasis is a chain of physiological reactions, the result of which is the appearance of a scar. The body became healthy, nothing more threatened, but there was a mark on the skin in the form of some form and type of scar. And this becomes an exclusively aesthetic disadvantage for the individual.

All physiological scars formed as a result of the normal physiological response of the organism in response to trauma have the same histological structure. It has already been said that normal scar tissue is a dynamic connective tissue structure that changes cardinally its pathomorphological picture, not only depending on the time of its existence, but also on the type of healing, the area and the depth of the original defect.

Depending on the period of existence, scar tissue has this or that quantity and ratio of cellular, fibrous and intercellular elements. However, it is equally important to know what morphological structures and elements are involved in the healing of the genius of the skin defect, since this is the possibility of preventing scarring or improving the appearance of scars, that is, the prevention of scarring. Investigations of the last summer mechanisms of wound healing do not exclude the possibility of non-scarring healing of deep wound skin defects with "wet" wound surface management. The moist environment allows the skin cells to interact freely with each other, moving along the intercellular matrix with the help of adhesive molecules and transferring information through cytokines and the corresponding receptors for restoring the normal structure of damaged tissues.

In the confirmation of this version, it was found that the fetal skin injuries in the prenatal period heal without scars. This is due to the fact that during the prenatal period, favorable conditions for the migration and exchange of information between skin cells have been created due to amniotic fluid. Keratinocytes and fibroblasts exchange information, coordinating the synthesis and decomposition of collagen, proliferative and synthetic activity, and the need and speed of migration. Due to this, collagen does not accumulate in the wound, and the keratinocytes move freely, quickly and without scarring fill the wound defect.