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What is Scar wound? Complications | Effects | Cause | Diagnosis | Treatment

A scar is a result of abnormal healing of wound with a mass of devascularised fibrous tissue covered by a single layer of epithelium, which contains no skin appendages or no lymphatics. During the process of healing the blood vessels are constructed by the collagen fibre of the fibroblasts, hence the scar is relatively avascular. 

Complications :

1. Contracture and deformity 

Scar contracts to one-third of its original length. 

Effects : 

1. Deformity: Especially of flexor surface of joints. 
2. Limitation of joint movement : False ankylosis 

Predisposing cause :
  • Infection 
  • burns 
Treatment :

Preventive : 
  • Splinting and early skin graft. 
Curative : 
  • Gradually stretching 
  • Excision and followed by a skin graft. Pedicle graft can only prevent subsequent contracture and at times Thiersch graft is better avoided.
  • Z plastic with rearrangement of scar lines. 
2. Keloid 

Keloid is a vascular hypertrophic scar. It is actually a form of soft fibroma, prone to recurrence, and is different from the usual hypertrophic scar. 

3. Adherent scar :

Scar adherent to underlying structures, Example - Scar of muscles to bone or cutaneous scar to muscles. 

Effect :
  • Painful during muscular contraction.
  • Quadriceps scar adherent to femurrestricts the movement of the knee joint. 
Treatment :
  • Active movement.
  • Excision - Especially when the cutaneous scar is adherent to muscle.
4. Painful scar :

Effect :
  • Nerve terminal included within the scar - causes local pain.
  • Terminal neuroma, especially in amputation stump.
  • Nerve trunk adherent to scar in its course.
Treatment :
  • Injection of local anaesthetic.
  • Excision of scar, if possible.
  • Re-amputation in a terminal neuroma.
  • Neurolysis - Release of entrapped nerve. 
5. Marjolin's Ulcer :

This is an epithelioma arising from the epithelium covering the scar. 

Effect :
  • It is a very slow-growing tumour as it is not very vascular. 
  • It is not painful as there are no nerve terminals. 
  • Lymphatic metastasis does not occur as there are no lymph vessels.
Diagnosis :
  • Ulcer developing over a scar.
  • Very slow-growing.
  • Foul-smelling discharge due to invasion by saprophytic organisms.
  • Irregular hard ulcer with everted margin.
  • Regional lymph glands not palpable. 
Treatment :
  • Early case : Wide excision followed by skin graft and deep X-ray.
  • Late case : Amputation if possible.
6. Ulcerated scar :

These are callous ulcers from impaired nutrition. The epithelium cracks and forms ulcer. 
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