Electron Microscopy of the Hypertrophic Scar

Hypertrophic scarring frequently occurs during or after the healing of deep second degree or third degree burns or equivalent trauma to the body surface. Clinically, the scar begins as a generalized firming or hardening of the skin area with an increased reddening over that of normal skin. These conditions intensify rapidly. The scar elevates and begins contracting, sometimes resulting in serious deformities, grotesque appearance, and severe loss of function. During development of the scar the reticular dermis undergoes an unusual reconstruction. The collagen fibers first become oriented into whorl-like arrangements, which most likely develop further into discrete nodules. The etiology of the hypertrophic scar is unknown. However, since nodular formation is so characteristic for the scar an examination of the nodule itself may suggest etiologic possibilities for the scar.