Wound Healing: Physiology and Pathology

The chapter aims to present the mechanisms of the wound healing process. The phases of wound healing and the type and treatment of pathological scars are described in detail. Factors influencing wound healing processes, both systemic and locoregional, are examined in order to better understand what can be helpful or harmful in this complex process and which results we can achieve by means of those factors. Alterations of the normal wound healing process can lead to the formation of pathological scars. If the scarring process is altered, connective tissues will respond in a wrong manner; if the connective tissues’ response is qualitative/quantitative in deficit, the result will be an atrophic scar; and if the response is excessive, there will be hypertrophic scars or keloids. As well as the causes, the main techniques for treating hypertrophic, keloid, and atrophic scars are also described. Potential treatments of hypertrophic scars and keloids are represented by a first line comprehending topical medications or, when indicated, surgical treatment, a second line represented by the corticosteroid injections, and finally third-line treatments reserved for more complicated cases including radiotherapy and use of chemotherapeutic drugs. Laser treatment has also been described for treating both atrophic and hypertrophic scars and keloids. Innovative liquid nitrogen use for scar flattening is additionally included in the chapter for its role in producing anoxia and necrosis of scar tissue. Pros and cons are also discussed in the association of any of the listed treatment options.