I am often asked to repair a wound because somebody says, “I don’t want the patient to have a scar.” Short of not having an injury, here are some ways to accomplish that.
Be a fetus
In early development, fetuses will heal without a scar. Scientists have known this for about thirty years, but they don’t know why.
Have a superficial injury
There are two main layers of skin: epidermis and dermis. “Epi” comes from Greek and means ‘above.’
Superficial injuries to the epidermis often heal very well. Injuries to deeper layer of skin (dermis) result in different scars. If you have stretch marks, either from muscle growth from bodybuilding, or from pregnancy, you have tears in the dermis. That’s why creams don’t work well for pregnancy stretch marks. But tummy tucks do!
Don’t get dirt trapped in the wound
A tattoo is a foreign body, usually ink, that is visible under the skin. In the case of a wound such as from road rash, there may be small pieces of foreign bodies under the skin. That’s why I try to scrub lacerations and wounds aggressively before closure. See this example of tattooing from a healed gunpowder injury – its something best to avoid.
Interestingly, tattoos can be used to cover up scars. These examples are extremely artistic. Note that tattoo ink does not take as well in scar tissue, so many of these designs leave the scar without color but tattoo the surrounding skin.
Plan how you get injured.
A horizontal scar on the forehead heals better than a vertical one. When planning a surgery, plastic surgeons will use Langer’s lines of skin tension to minimize the visibility of scars.
Skin around joints generally heal with wider scars. Just look at anybody’s knee replacement. Other areas of poor healing include the area exposed in a v-cut shirt. But just above the shirt, skin of the neck tends to heal well.
Be albino, maybe.
Scars tend to have different in color than surrounding skin. Usually injuries heal with hypopigmentation, or a lighter color than the surrounding skin. This occurs even though the amount of melanocytes (color containing cells) in scar tissue is the same as uninjured skin. Occasionally, injuries such as burns can heal with hyperpigmentation (darkening). While dermatologists and plastic surgeons use the Fitzpatrick scale for determining skin types, race in and of itself is not a criteria used to differentiate healing capacity.
Conclusion
There are things that can be used to minimize the risk of a bad scar. The only way not to have a scar is to not have an accident – and accidents are just part of life. Please be safe everybody!
In the next newsletter, I will describe things I do to minimize scarring.
