Scar Tissue and Scars - Formation, Problems and Treatment

Scar tissue is tissue that forms in an injured area of our bodies and stays there after the injury has healed. It replaces cells that have been destroyed and may appear both inside the body and on its surface. Scar tissue on our skin looks different from the surrounding area and is often known as a “scar”. Scar tissue on skin or on an organ or internal structure acts as a barrier and protects the place that was injured, but it lacks the functionality of the original tissue and has low elasticity.

Formation of scar tissue is a normal activity in our bodies and occurs whenever we have more than a minor injury. However, some scar tissue may be abnormal or may cause cosmetic or more serious problems. Some people develop hypertrophic scars on their skin, which are larger than normal scars and have a lumpy appearance. Keloid scars are raised scars that spread beyond the wound and continue to grow. Atrophic scars are sunken scars that form depressions in the skin. An adhesion is a band of scar tissue that forms an unnatural connection between different organs or internal body structures. Scar tissue formation inside organs or body structures may cause serious problems, since the presence of extensive scar tissue interferes with the organ’s function.

Scar tissue is made of fibrous connective tissue. This tissue contains a fibrous protein called collagen, as well as long carbohydrate molecules called polysaccharides, water and cells called fibroblasts, which make the collagen. Fibrous connective tissue is also known as dense connective tissue, because the collagen fibers are densely packed in a roughly parallel arrangement and there are comparatively few cells present. Fibrous connective tissue is a normal component of the body and is present in uninjured areas. However, researchers have discovered that the connective tissue in scars has a slightly different structure from normal fibrous connective tissue.

Causes of Scars

Scars may be caused by wounds, burns, surgical incisions, physical injury, chemical injury, infections, diseases, inflammation and acne.

Scar Appearance

Scars on the skin are red when they are first made due to an increased blood flow as the wound heals. Over time, the blood supply decreases and the scar becomes paler than the surrounding skin. Scars may take many months or even years to reach their final form. Skin scars are thicker than their surroundings. The scar lacks hair, sweat glands and melanin, the chemical which protects the skin from ultraviolet radiation.

Reducing Scar Formation

The first structure that forms in a wound is the blood clot, which prevents blood loss. The blood clot may be replaced by scar tissue. Skin scarring can be reduced by making sure that the edges of a wound are brought close together during the healing process. When the edges of a wound gape, scar tissue will be formed to fill in the gap.

Good dressings, good nutrition and appropriate medications, such as antibiotics, can help protect and defend an injured area, but the amount of scarring and the final appearance of a scar depend mainly on genetics, the way our individual body works and our age. Older people tend to scar more easily than younger people. Their bodies are less likely to form enough normal skin cells to replace the ones that have died in an injury.

We can help our bodies decrease scar formation but we can't avoid it completely. Surgeons are well aware of the body's tendency to scar and often try to make their incisions in a direction or a place that will minimize this process, or that will minimize the scar's visibility.

Hypertrophic Scars

In a hypertrophic scar too much collagen is made, and the scar forms a raised area or lump above the wounded area of the skin. The lump is often pink in its early stages and may be itchy.

Keloid Scars

Keloid scars grow beyond the wound, forming a reddish tumor. This tumor is benign (not cancerous) and consists mainly of collagen. Keloid scars may form as a response to injury, but in some people they form spontaneously, with no known cause. They may be itchy and create a burning sensation.

Atrophic Scars

Atrophic scars look like pits in the skin and may be formed during skin problems such as acne and chicken pox. In this case not enough connective tissue is formed to fill in the wound.

Scars on the skin can’t be completely removed once they form, but they can be treated to improve their appearance, sometimes very significantly, and make them less noticeable. Scar treatments generally require weeks or months to be effective. Most scars fade to some extent on their own as time passes.

Pressure applied to a scar or silicone sheets placed over the scar often improve its appearance. These treatments flatten raised scars and make scars paler. Doctors may inject corticosteroids into a raised scar to inhibit collagen synthesis and reduce inflammation.

Surgical techniques can remove some scars, but the body may make a fresh scar as it heals itself from the surgical wound. However, the new scar may look better than the old scar.

In dermabrasion, the surface layer of scarred skin is removed in an abrasive process. Laser surgery can be used to remove the raised surface of a hypertophic or keloid scar. A different type of laser treatment can improve the appearance of acne scars. The treatment stimulates the formation of new collagen, which partially fills in the pitted areas. Skin grafts may be used to cover some scars, such as those created by burns.

Some Causes of Internal Scar Tissue

Adhesions inside the body arise due to inflammation caused by trauma such as surgery or infections. As a result of the trauma fibrous bands or sheets form and connect structures or different parts of the same structure. Scar tissue production in the heart may be caused by a heart attack and the accompanying death of heart muscle. Cirrhosis of the liver, a condition in which the normal liver tissues are gradually replaced by scar tissue, may result from excessive alcohol consumption, hepatitis C or obesity.

Some Effects of Internal Scar Tissue

Adhesions often cause no symptoms, but they sometimes produce pain and other problems. Adhesions may cause organs to change their shape or move out of their correct positions. They may also prevent the movement of a structure that should be moving. Scar tissue in the heart may increase the chance of an irregular heartbeat (arrhythmia) because the damaged tissue interferes with the electrical signal that triggers the heartbeat. The liver has many vital functions. Cirrhosis of the liver is therefore a very serious condition, since the scar tissue can’t perform the liver’s normal jobs.

Some Treatments For Internal Scar Tissue

Adhesions may improve on their own, or they can be removed surgically. However, there is a risk that new adhesions will develop after the surgery. Doctors sometimes place a thin barrier material around an organ during surgery. The barrier prevents the attachment of adhesions and eventually dissolves.

Doctors do have some techniques for dealing with scar tissue in hearts, livers and other organs, but extensive scar tissue is hard to manage. Cirrhosis of the liver is especially serious because once the process starts, the replacement of liver tissue with scar tissue is progressive. It's much easier to prevent cirrhosis than to treat it.

Scar tissue formation in our bodies is unavoidable, but the good news is that there are steps that we can take to prevent or reduce the process. Proper wound treatment and a healthy lifestyle can decrease the probability of scar tissue formation, or decrease the amount of scar tissue that's made. In addition, in some cases medical treatments can remove the scar tissue, or at least some of the tissue, once it forms.