Healing II: Complications

Complications during healing arise when tissue repair is altered by local or systemic factors. These changes involve abnormal collagen deposition, altered biomechanics, and reduced vascular supply, impairing restoration of normal structure and function.

Loss of Function

Scar tissue differs significantly from the original tissue it replaces. In the skin, fibrosis lacks adnexal structures such as hair follicles, sebaceous glands, and sweat glands. Their absence reduces tactile sensitivity, impairs thermoregulation, and limits lubrication of the epidermal surface. As a result, healed areas may exhibit dryness, decreased sensation, and reduced heat dissipation.

Contractures and Adhesions

Excessive collagen cross-linking and myofibroblast activity can cause scar tissue to tighten over time, producing contractures. These deformities restrict joint mobility and are especially common after deep burns, where large areas of dermal loss promote extensive fibrosis. Internally, adhesions form when fibrous bands develop between adjacent tissues or organs. Postoperative patients, particularly those undergoing abdominal surgery, are prone to adhesions that may tether intestinal loops and increase the risk of bowel obstruction.

Abnormal Scar Formation

Hypertrophic scars arise from exuberant collagen deposition that remains confined to the original wound boundaries. In contrast, keloids extend beyond the initial injury and invade surrounding skin. Both lesions reflect dysregulated fibroblast activity and persist due to impaired extracellular matrix remodeling.

Impaired Circulation and Ulceration

Scar tissue has reduced vascularity compared with normal tissue. When fibrosis compromises regional blood flow, oxygen and nutrient delivery decline, predisposing the area to tissue breakdown. Chronic ulcers can form in regions subjected to mechanical stress or where perfusion is already limited, such as the lower extremities in individuals with vascular disease. These complications illustrate how disrupted healing can impair long-term tissue integrity and function.