An overview of the two widely accepted, but contradictory, theories on wound contraction

Pellard, S.

doi:10.12968/jowc.2006.15.2.26885

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…The exact mechanism by which cutaneous wounds contract is not well understood although two different mechanisms have been proposed. These have been reviewed recently by Pellard 19 . The first, or cell contraction theory, proposes that myofibroblasts within the granulation tissue contract and in doing so pull on collagen fibrils.…”

Section: Discussionmentioning

confidence: 99%

“…The subsequent contraction and reorganization of collagen fibrils generates a force, which acts through the granulation tissue and brings in the margins of the wound. Numerous studies have implicated fibroblasts and myofibroblasts in wound contraction 19 but the mechanisms by which this occurs is unclear. A porcine study in which the central granulation tissue was excised from the wounds did not reduce the rate of contraction 20 .…”

Section: Discussionmentioning

confidence: 99%

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Effect of artificial dermal substitute, cultured keratinocytes and split thickness skin graft on wound contraction

Reid

Currie

James

et al. 2007

Wound Repair Regeneration

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In this study, the effect of different wound treatments on contraction was evaluated in an established porcine model. In two separately conducted experiments full thickness wounds treated with artificial dermal substitute, split thickness skin graft (STSG), meshed STSG applied in combination with cultured keratinocytes or meshed STSG alone were compared with untreated wounds. The surface area of all wounds was quantified at regular time intervals. After 20 days wounds from some groups were subjected to histological analysis to establish the degree of epithelialization. Wounds treated with STSG contracted more than with artificial dermal substitute until day 21. From day 21 to day 35 wounds treated with STSG showed the least contraction. Wounds sprayed with cultured keratinocytes demonstrated a slower rate of contraction than those with meshed STSG alone after 20 days. The untreated control wounds showed a greater rate of contraction and had almost closed by day 20. This study demonstrates that there is a significant difference in contraction between wounds treated with artificial dermal substitute and control wounds and between wounds treated with STSG with cultured keratinocytes and meshed STSG alone. STSG with cultured keratinocytes, unmeshed STSG, and artificial dermal substitute all reduced wound contraction significantly.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of artificial dermal substitute, cultured keratinocytes and split thickness skin graft on wound contraction

Reid

Currie

James

et al. 2007

Wound Repair Regeneration

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“…the dermis) retains its shape after application of an external mechanical load. In case of a skin defect, as in burns, the protecting matrix structure of the collagen network is lost, and all kinds of biomechanical and biochemical processes are generated to activate the fibroblast to migrate and play a role in the wound healing process (34,54,57,58).…”

Section: Severity Of Burn Scar Contracturementioning

confidence: 99%

“…However, before the fibroblasts can do their work, they first must migrate to the wound area. Therefore, they contact the ECM and pull themselves along the collagen fibrils to the wound area, generating traction forces in the ECM (58). Thus, the fibroblasts, as well as the collagen fibrils, will be reorganized along the lines of tension ( 29,79).…”

Section: The Fibroblast In Wound Healingmentioning

confidence: 99%

“…(1989) reported that fibroblasts migrating along the ECM initiate traction forces that are sufficient to close small defects by themselves. This process is called cell-traction (27,58). As soon as the fibroblasts enter the wound they will proliferate on a large scale and will start synthesizing a new collagen-containing matrix called granulation tissue.…”

Section: The Fibroblast In Wound Healingmentioning

confidence: 99%

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Burn scar contracture, perspectives on prevalence, severity, and rehabilitation interventions.

Schouten

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SUMMARY The goal of this thesis was twofold. Firstly, creating awareness of the possibilities and impossibilities of preventing or minimizing burn scar contracture development by splinting therapy and stretching interventions. Since the rationale behind splinting therapy is to counteract the contractile forces of the healing scar tissue, the literature was reviewed for the response of the contracting burn wound to the mechanical load applied using splints. Many experimental studies have reported that mechanical tension exerted by static splinting therapy will actually stimulate myofibroblast activity, resulting in the synthesis of new extracellular matrix (collagen) and the persistence of contractile activity. This suggests that static splinting therapy may even worsen the scar contracture formation, and thus contradict its purpose. In view of these findings, it is uncertain if splinting therapy is a realistic intervention for the prevention of burn scar contracture. Furthermore, an ex-vivo experimental study was conducted to examine the effect of stretch on healthy skin and matured scar tissue with the focus on collagen orientation and structure. Results of this study showed that scar tissue had significantly less potential to increase in length compared to healthy skin. The results of the review on splinting therapy and the ex-vivo experimental study on stretching matured scar tissue suggest that stretching exercises and splinting therapy may not be effective interventions. And secondly, a long term prospective multicenter cohort study was conducted for the first time to identify the prevalence and severity of burn scar contracture development. The results of this study showed that conservatively healed superficial burn wounds, across or adjacent to joints, were of no threat for burn scar contracture development in the long term, despite a rather high prevalence of ROM limitations in the acute phase. Burn scar contracture development in the long term was exclusively the result of joints that were skin grafted. However not all joints that were skin grafted resulted in a burn scar contracture. More than half of the ROM limitations of those joints seen in the acute phase resolved within 12 months. Furthermore, the degree of ROM limitation of all joints diminished overtime and a part of them even normalized to the full ROM. Indicating that the prevalence and degree of ROM limitations in the acute phase have little predictive value for the prevalence and degree of ROM limitation of burn scar contracture development in the long term. Furthermore, the pattern of the course of the prevalence and degree of developing burn scar contractures differed markedly between joints and planes of motion. Interpretation of the degree of limitation of a burn scar contracture in terms of severity is not just a matter of qualifying the loss of range of motion of a joint, but depends largely on the extent to which impaired joint mobility interferes with the functional needs of the individual burn patient in terms of daily activities and participation in society. Comparing the overall results of this longitudinal study with previous studies showed little consistency, which stresses the need for uniform study designs, measurement protocols, study population, timing of measurement and definition of a burn scar contracture.

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The use of Integra artificial dermis to minimize donor‐site morbidity after suprafascial or subfascial dissection of the radial forearm flap

et al. 2011

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An overview of the two widely accepted, but contradictory, theories on wound contraction

Abstract: A wound repairs itself in three phases: inflammation, proliferation and maturation. Wound contraction is a final feature of the proliferation phase, and is defined as the mechanism by which the edges of an open wound are drawn together as a result of forces within the wound.

Cited by 5 publications

References 21 publications

Effect of artificial dermal substitute, cultured keratinocytes and split thickness skin graft on wound contraction

Effect of artificial dermal substitute, cultured keratinocytes and split thickness skin graft on wound contraction

Burn scar contracture, perspectives on prevalence, severity, and rehabilitation interventions.

The use of Integra artificial dermis to minimize donor‐site morbidity after suprafascial or subfascial dissection of the radial forearm flap

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