Current concepts in scar evolution and control

The basic principles influencing scar expression and outcome have long been defined. Although these were relatively clear at the time, the exact events at a molecular level were poorly defined. The past decade has delineated the myriad of events that occur in the run-up to scar evolution far more clearly, although the intricate details have yet to be elucidated. What is clear is that a series of conversations and crosstalk takes place in the cell cytosol, in the cellular nucleus, and outside the cell within in the extracellular matrix. This interaction or "dynamic reciprocity" takes place via a series of signals, protein activation, ionic translocations, and receptor transactions. Marrying the previously defined principles with current described cellular/extracellular matrix (ECM) interactions enables us to describe more accurately the crosstalk occurring in scar evolution and possibly to influence the "wording" of that crosstalk to improve scar outcome. Thus, the principles of mechanostimulation and scar support, hydration occlusion, controlled inflammation, and collagen/extracellular remodeling are discussed with possible interventions in each category.