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Wound Healing Disturbances: The Unfavorable Result

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Soft Tissue Injuries of the Head and Neck

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Abstract

There are four distinct but overlapping phases of wound healing: hemostasis (vasoconstriction, activation of platelets, formation of fibrin matrix), inflammation (release of mast cell mediators, modification of vascular permeability, passage of neutrophils to the site of injury), proliferation (fibroblast proliferation, neoangiogenesis), and remodeling (maturation of granulation tissue into a scar). Acute wounds progress through the healing phases in an orderly fashion for normal healing to occur. However, pathologic responses may occur. Hypopigmentation (scar lighter than normal tissue) and hyperpigmentation (scar darker than normal tissue) are healing anomalies of pigmentation. Hypertrophic scars and keloids are healing disturbances manifesting as excessive scarring. Treatment of hypertrophic scars depends on scar contracture severity. In less severe cases, conservative therapies (silicone gel sheeting, compression garments, intralesional injection of corticosteroids/5-fluorouracil, laser therapy) are indicated. In severe cases, surgery is the first choice. Keloid treatment depends on the number and size of the lesions. Small and single keloids may be treated by surgery with adjuvant therapy (e.g., radiotherapy) or multimodal conservative therapy. For large and multiple keloids, volume- and number-reducing surgery is a choice. Other scar problems are the stretched scar, crosshatching, malaligned scars, trapdoor scars, anatomical mismatch, unstable scars, and collagen defects. Specific problems related to the various anatomic areas of the face (scalp, eyebrows, eyelids, lacrimal system, nose, lips, and neck) are further highlighted.

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  1. Plastic Surgery, IASO HOSPITAL GROUP, Consultant P/R Surgeon, Athens, Greece

    Charilaos A. Ioannidis

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Ioannidis, C.A. (2023). Wound Healing Disturbances: The Unfavorable Result. In: Soft Tissue Injuries of the Head and Neck. Springer, Cham. https://doi.org/10.1007/978-3-031-14915-3_12

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