Examination notes

How do wounds heal?

Skin scarring is the normal and inevitable outcome of cutaneous wound healing. Wound healing follows a sequence of overlapping phases: haemostasis, inflammation, proliferation and remodelling.

What factor must be considered on inspection?

1. • Cause: Consider underlying medical comorbidities that led to the scar, but never assume the surgical procedure if this information has not been given.

2. • Colour: An assessment of the colour of the scar may indicate its age. Wound healing has defined sequential yet overlapping stages within which the scar will change in colour. As a scar passes from the proliferative phase through to remodelling and finally into a mature scar so its colour will decrease in red pigmentation. A variegated pink scar is younger than a homogeneous white scar.

3. • Location: The position of the scar indicates potential functional complications. If the scar is over a joint there is a risk of contractures causing decreased range of movement. Assess for underlying neurovascular function and deficits following surgery or injury: for example, periorbital scars may be associated with ectropion directly from cicatricial healing, or weakness due to damage to the temporal branch of the facial nerve (CN VII), or a sensory loss due to trigeminal nerve (CN V1) injuries.