Ultrastructural differentiation of abnormal scars.

AIM To evaluate the differences between keloid and hypertrophic scars by biochemical and ultrastructural techniques. METHOD Over 1000 patients with different types of scars were studied and followed up for a period of 20 years. The histochemical and biochemical analysis with respect to the composition of the extracellular matrix of the dermis was conducted. At the ultrastructural level, collagen deposition and assembly were studied using electron microscopy. The rate of proliferation and metabolic activity of the dermal fibroblasts isolated from the normal skin and scar biopsies were studied to assess the cause of excess matrix deposition in scar tissues. RESULTS Evaluation of different types of scars showed that both keloid and hypertrophic scars have excess matrix deposition in terms of collagen and proteoglycans. Keloid shows a high amount of acid-soluble collagen. The assembly of collagen fibrils is also abnormal in keloids. Studies on the proliferation and metabolic activity showed that keloid fibroblasts have a higher rate of proliferation and metabolic activity than fibroblasts from hypertrophic scars and normal skin. Finally, keloid fibroblasts show high and intense staining for the endoplasmic reticulum, suggesting a possible reason for high activity of these fibroblasts. CONCLUSION Keloids and hypertrophic scars show distinct ultrastructural patterns of both collagen deposition and assembly. These parameters could be refined by further research, and they would thus serve as a useful tool for surgeons to distinguish different types of scars and adopt suitable therapeutic strategies.