Wound Healing and Scarring

Duration of therapy is determined by speed of recovery of the affected joint or resolution of a haematoma. After surgery at least 10-14 days of replacement therapy is required to ensure adequate wound healing and scar formation. 

Kim DW, Ahn DS. Delayed wound healing and scarring after combined ablative laser and phenol peel treatment. J Plast Reconstr Aesthet Surg 2010 63(5) e484-5. 

There are many types of EDS, but they are generally characterized by hyperextensible skin and joints, poor wound healing and cigarette paper" scars (ragged, gaping malformed scars), bruising, and other structural manifestations. 

The influence of mechanical forces on skin structure and remodeling has been studied extensively in an attempt to do the following to understand wound healing and reduce hypertrophic scarring, to increase the skin surface area using balloon expanders, to study the reorganization and... 

As mast cells are normally found in skin, this recruitment of mast cells may simply reflect the restoration of normal tissue homeostasis, although they may play an intermediate role. Mast cells are also found in keloids and hypertrophic scars (Smith etal., 1987), both of which are considered to be abnormal typ>es of wound healing, and it has been su ested that this provides further evidence of their involvement in fibrotic responses. 

Chowdhury S, et al. Pirfenidone nanoparticles improve corneal wound healing and prevent scarring following alkali bum. PLoS One 2013 8(8) e70528. 

Psyllium polysaccharides have been shown to promote wound healing and to reduce scar formation through various mechanisms in in vivo and in vitro models. ... 

You will need to watch this patient closely as they may develop delayed wound healing and a potential for scarring with hypopigmentation or keloid formation. You can never go back, so it is better to err on the side of the light white. It is difficult to neutralize TCA to prevent this burn. Usually, by the time we see the deep white or yellow it is too late to neutralize. However, those with experience like Kim and Bill Cook can neutralize with a spray of bicarbonate solution within seconds of application. They can control the higher strengths. This takes practice. 

Before performing the peel, an extensive patient history should be obtained, with particular attention paid to a history of delayed wound healing and hypertrophic scar formation. Also, dark skin patients must be questioned about their general health status, medications, smoking, previous cosmetic procedures, such as surgical lifts or fluid silicone injections, keloid formation, side effects and results of previous cosmetic procedures, etc. If a patient has a history of recurrent herpetic outbreaks, prophylactic and postpeel antiviral treatment should be used. Systemic medications such as oral contraceptives... 

Recently, some studies of wound healing and fibroblast growth have indicated that both pantothenic acid and ascorbic acid are involved in trace element distribution in the skin and scars of experimental animals, and that pantothenic acid can improve skin and colon wound healing in rabbits. It is not yet known whether these observations are relevant to wound healing in hmnans. 

Jarvinen, T.A.H., Ruoslahti, E., 2010. Target-seeking antifibrotic compound enhances wound healing and suppresses scar formation in mice. Proc. Natl. Acad. Sci. 107 (50), 21671-21676. 

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