UNDERSTANDING WOUND HEALING

The following happens in the wound healing process before you start to see scars.
Hemostasis – Immediately after injury
Vascular and cellular responses
Release of cytokines – pDGF, TDGF-β, eGF
Vascular constriction – lasts for 5 – 10 minutes
Coagulation
Fibrinoplatelets deposited to stop bleeding
Clot formation
Wound edges are still not united – wound still open
Inflammation – happens after injury
Can last from 1 – 5 days
Experience of swelling, pain and redness
Early inflammation– feeling of pain, warmth and edema
Plasma fluid & protein, antibodies, leukocytes and red blood cells enters the injured area.
Late inflammation– micro circulation slows down
Histamine, serotine, protoglandins appear
Neutrophils & monocytes move towards wound area to ingest wound debris
The repair process starts
Proliferation – starts at about 72 hours after injury
Reconstruction of injured tissue
Lasts from 2nd to 20th day approximately

Growth factors are released
Fibroblasts begin to produce collagen at the wound area
Main types of collagen produced are types I & III (80% type I)

Formation of the extracellular Matrix (ECM) and granulation tissues

Angiogenesis occurs – capillary growth into the ECM

Cellular structure is regenerated
Collagen forms to give wound tensile strength
Reconstruction
Re-epithilization starts by the 3rd week
Process of contraction is almost complete

Maturation – Remodelling
Rate of collagen deposits slows down after about 3 weeks from injury
Remodelling of collagen deposited occur for months after injury
Excessive mass of collagen and ground tissue cause formation of scar

SCAR FORMATION

Scars formed as a result of injuries - for example:
Scrapes & scratches Cuts Injuries
Surgical procedures Burns Acne

When the skin is injured, fibroblasts produce collagen to fill and close the wound
Collagen is a tough, fibre-like protein that is present in normal skin
After the wound has healed, it will always leave a scar
The reason for bad scarring appear can be due to various factors for example:
Severity of wound Inappropriate wound healing
Location of wound Ethnic background
Genetic factors Age

Most part of the scar tissue is made up of collagen fibers.
In bad scars, the collagen fibers are more numerous (especially excessive collagen type III) and haphazardly arranged

SCAR TYPES

There are basically 4 types of awful scars
Keloids Hypertrophic scars
Hypotrophic scars Post Inflammatory Hyperpigmented scars

Keloids
 Very thick clusters of scars formed from excessive tissue
The appearance of the scars is often red or purplish in color
Keloids often grow and extend outside of the wound area
Keloids are very difficult to treat and have a tendency to reappear after treatment
Various treatment methods include corrective surgery and steroid injections

Hypertrophic Scars
Thick, red and raised scars
Hypertrophic scar tissues remains within the boundaries of the wound area
They can be improved with scar removal methods

Hypotrophic Scars (or Atrophic Scars)
Hypotrophic scars appear sunken, formed a depression below the skin level
These scars form from deficiency in tissue formation
Example: Acne scars; Chicken pox scars
Hypotrophic scars can be improved with dermabrasion or laser therapies

Post Inflammatory Hyperpigmented Scars
These scars are pigmented but not raised ore sunken
Can be avoided with early prevention
Existing pigmentation can also be improved

SCAR THERAPIES

There are many modalities of scar treatment & management
The following are examples:

    

WOUND HEALING PROCESS AND CONVENTIONAL SCAR THERAPIES

Reducing the risks of bad scar formation
It is better to avoid bad scarring before the scars appear.
Risks of bad scar formation can be reduced with early care and attention to the wound area.
Apply Cybele Scagel as soon as the wound closes (upon complete epithelization)
Should bad scars start to appear, doctors may advise additional methods of scar management
In some cases, corrective surgery or other invasive methods may be required to improve the scars.

    SCAR CARE WITH CYBELE SCAGEL IN SCAR MANAGEMENT

 EXAMPLE OF CYBELE SCAGEL USED IN COMBINATION THERAPY
                    Closed wound and scarring from burn incident


                      Care for the skin by applying Cybele Scagel


            Combining use of silicone gel sheet after Cybele Scagel


               Ensuring the silicone gel sheet is applied properly


         Using elastic bandage to hold the silicone gel sheet in place


Additional combination with presure therapy by using pressure garment