Patient Informational Library

Understanding Scars

When a person trips and falls on gravel, grazing his/her leg, a road-rash may occur.. A scab may form. When the scab falls off, the skin may be pink or reddish, but over time this fades and the skin returns to normal. Injuries like these are partial thickness and are likely to heal without significant scarring. This is because there is sufficient remaining skin to regenerate the surface layers. Initially a scab may develop.

When a full thickness injury through the skin occurs, whether it be due to an accident or following surgery, the skin does not regenerate but rather it heals with scar tissue. Scar tissue consists of collagen, whereas skin consists of dermis and epidermis. Although scar tissue is similar to skin, it is not identical and that is why a scar can always be differentiated from regular skin.

For the above reasons scars are permanent. A person who has had their appendix surgically removed will have a lifelong scar that does not disappear.

When an open wound is closed with stitches, the area will heal with a scar. The surgeon has a very small role to play in the healing of the scar. The surgeon is able to stitch the skin edges so that they are edge-to-edge and flush. The healing that occurs thereafter depends on many factors, some of which include: the patient's genetic makeup, tension on the scar, separation of the wound edges and the development of infection in the wound.

Factors such as smoking, sugar diabetes, or stretching of the wound may also contribute to a wide or thick scar.

Scar tissue is 80% as strong as natural skin. When a wound is closed, the skin along each side of the wound edges are pulled together with stitches. The skin, being elastic, tries to return to its original position. The scar, which is weaker than the natural tissue, will stretch and this may produce a wide scar. Scars also can thicken and bulge above the level of the skin. This may occur in an attempt to prevent the elastic skin pulling the scar apart.

Scars tend to thicken for three months and then soften and flatten over a period of a year or two. The red color of the scar will also fade over a period of a year or two.