Biology and principles of scar management and burn reconstruction

Surg Clin North Am. 2014 Aug;94(4):793-815. doi: 10.1016/j.suc.2014.05.005.


Hypertrophic scarring is extremely common and is the source of most morbidity related to burns. The biology of hypertrophic healing is complex and poorly understood. Multiple host and injury factors contribute, but protracted healing of partial thickness injury is a common theme. Hypertrophic scarring and heterotopic ossification may share some basic causes involving marrow-derived cells. Several traditional clinical interventions exist to modify hypertrophic scar. All have limited efficacy. Laser interventions for scar modification show promise, but as yet do not provide a definitive solution. Their efficacy is only seen when used as part of a multimodality scar management program.

Keywords: Burn reconstruction; Fibrocytes; Heterotopic ossification; Laser; Scar.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Burns / pathology
  • Burns / physiopathology
  • Burns / therapy*
  • Cicatrix, Hypertrophic / pathology
  • Cicatrix, Hypertrophic / physiopathology
  • Cicatrix, Hypertrophic / therapy*
  • Contracture / therapy
  • Cytokines / antagonists & inhibitors
  • Cytokines / metabolism
  • Fibroblasts / pathology
  • Fibrosis / pathology
  • Humans
  • Interferons / therapeutic use
  • Laser Therapy / methods
  • Plastic Surgery Procedures / methods
  • Postoperative Care
  • Receptors, CXCR4 / antagonists & inhibitors
  • Time Factors
  • Toll-Like Receptors / physiology
  • Wound Healing / physiology


  • Cytokines
  • Receptors, CXCR4
  • Toll-Like Receptors
  • Interferons