It is also important to consider which layer the wound affects, as the skin is composed of three layers: the epidermis, the dermis and the hypodermis or subcutis. The epidermis is the most superficial layer and is in contact with the exterior, while the hypodermis is the deepest layer, in contact with the interior of the body.
The intermediate layer of the skin is the dermis and can form pathological scars when affected by a wound deep enough to penetrate it. The dermis is a very specialized tissue and therefore trying to repair it is challenging.
First, let’s see how the skin reacts to a wound to form a scar, then we’ll talk about the different types of wounds.
Stages of recovery
When skin is injured , it triggers a series of sequential events to repair it. The way these stages occur is what determines the types of healing. There are five stages of healing:
1. Coagulation and vascular response
As soon as an injury occurs, blood washes the wound. Foreign matter is flushed out to prevent infection. Then, with the help of platelets, the veins are closed to clot and stop the bleeding.
2. Inflammation
The second stage is inflammation. Although the skin may become red, this is not a sign of infection. The redness of inflammation is caused by intense cellular movement and increased blood flow. A clear inflammatory fluid may even form in the wound, which is not a sign of infection.
3. Granulation
Now the essence of repair begins. The cells most involved are fibroblasts , which travel to the injury site to produce collagen . Collagen is the main component of the dermis; therefore, it replaces the lost tissue.
Discover more: Exfoliation Injuries: What Are They and How Are They Classified?
4. Epithelialization
A final function of repair is to restore the layer that separates the outside from the inside. The skin has a barrier function thanks to the epidermis. Epithelialization involves regenerating the lost epidermis through cells called keratinocytes .
5. Restructuring
Once the wound is closed, the body’s healing process determines the final appearance of the wound. If the wound only affects the epidermis, there is usually only cell turnover and the scar is usually normal. If it is deep, however, it is more likely to be a pathological scar
Types of recovery
The stages of skin healing are always the same for all wounds, but not all wounds are the same. This is why three types of healing processes are defined in the world of dermatology and surgery:
Primary recovery
This is the process that occurs when the wound is small, not deep, and the edges of the wound are close . It usually does not leave a long-term scar.
Secondary recovery
This is the healing process of a deeper wound affecting the dermis. The result is usually a larger than normal scar with a noticeable appearance. The main cause is tissue loss or the presence of too much distance between the edges of the wound. When this happens, the dermis must create a lot of new tissue in the granulation phase, which is responsible for the final scar.
Tertiary recovery
This type of scar is associated with medical intervention. This scar occurs when the surgeon places a second stitch over an existing one or performs a skin graft for repair. Medical intervention causes this final scar.
You may also be interested in: 6 Steps to Treating an Infected Wound
Types of wounds
While there are normal and expected scars, there are also scars that medicine considers pathological. Let’s see how they are medically classified:
- Normal: occurs after a routine procedure. The final result is a fine line.
- Atrophic: A loss of skin tissue where there is a small depression at the site of a wound. This is very common in acne , for example.
- Hypertrophic: Scars caused by types of wounds that have excessive collagen production. The resulting skin is thick and protrudes above the normal epidermis level. It usually occurs in areas of skin that are in constant movement, such as the knees.
- Keloid: an extremely large hypertrophic scar. It may itch and even burn a little. It usually extends beyond the initial borders of the wound that created it.
- Contracture: These are the scars left from burns . The scar tissue contracts and deforms the affected area.
Each of these types of healing, which result in different scars, has a medical approach. If you have a scar that concerns you, you can consult a surgeon or dermatologist . The specialist will know and will be able to tell you the best approach for you.
