Skin: Histology and Physiology of Wound Healing

It is important to understand the histology and physiology of skin for the prediction and optimization of wound healing. Optimal postoperative wound healing to minimize scarring entails minimizing local, systemic, and environmental factors that lead to poor wound healing. Keeping the wound clean and moist, minimizing trauma, and infection are the local wound tenets. Systemic tenets include minimizing medications that inhibit processes of wound healing, maintaining adequate nutrition, pain palliation, UV protection, and smoking cessation. This article presents the dynamic process of wound healing and the basic tenets to minimize scarring.

1.

Skin is composed of several layers that are essential to its function and response to injury: the epidermis, dermis, and hypodermis. Healing is a dynamic progression encompassing hemostasis, inflammation, proliferation, and remodeling
2.

Pilosebaceous units are the source of all epithelial stem cells essential for reepithelialization and wound healing
3.

Multiple extrinsic and intrinsic factors affect healing, specifically the effect of immune system modulation (medications and diseased states)
4.

It is most optimal to wait at least 4–6 weeks after smoking cessation for elective surgical interventions
5.

Keloids and hypertrophic scarring are a result of overabundant collagen production, and decrease collagen breakdown. Keloids are difficult to treat, due to their recurrent nature. It is important to identify individuals prone to keloid formation for surgical planning purposes