Wound dehiscence, excessive scarring, and contractures
THE CONTEXT
Abnormal repair may produce wound rupture, excessive scar tissue, or exaggerated wound contraction.
Wound dehiscence
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Failure of healing may lead to dehiscence or rupture of a wound. Although uncommon, this occurs most frequently after abdominal surgery.
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Vomiting, coughing, or ileus can generate mechanical stress on an abdominal wound and cause rupture.
Hypertrophic scars and keloids
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Excessive formation of repair components can produce hypertrophic scars and keloids.
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Hypertrophic scars contain abundant myofibroblasts, often grow rapidly, and tend to regress over several months.
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Hypertrophic scars generally follow thermal or traumatic injury involving the deep dermis.
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A keloid grows beyond the boundaries of the original wound and does not regress. Keloid formation appears to reflect an individual predisposition.
Contractures
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Wound contraction is part of normal healing. Exaggerated contraction causes contractures that deform the wound and surrounding tissues.
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Contractures particularly affect the palms, soles, and anterior thorax.
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Contractures commonly follow serious burns and can compromise joint movement.
Chronic wound morphology and fibrosis
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The illustrated arterial ulcer shows more extensive tissue necrosis. The diabetic ulcer shows an ulcer crater, chronic inflammation, and granulation tissue.
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Fibrosis denotes excessive deposition of collagen and other extracellular matrix components in tissue.