World Journal of Surgery

, Volume 4, Issue 3, pp 279–287 | Cite as

Contraction and the control of contraction

  • Ross Rudolph
Article

Abstract

Wound contraction is a basic mechanism for wound closure that can be lifesaving. Yet, wound contraction can also produce considerable deformity and misery in conditions as diverse as burn scar contracture, cirrhosis, Dupuytren's contracture, and contracture around silicone tissue implants. Current evidence suggests that wound contraction is a cellular function of contractile fibroblasts (myofibroblasts). These cells share the electron microscopic appearance of both fibroblasts and smooth muscle cells. Pharmacologically and immunologically, myofibroblasts have many characteristics of smooth muscle cells. Active wound contraction caused by myofibroblasts can lead to fixed, rigid scar contracture. Contracture associated with poor joint positioning can also occur passively due to collagen reorganization alone, without myofibroblast involvement.

Control of contraction (and contracture) can be achieved theoretically by 3 modes of therapy. Physical means, including range of motion exercises, splinting, and full thickness skin grafting after surgical release, are used currently. Biochemical control of myofibroblast contraction by agents that affect tissue-cultured fibroblasts has the potential of reducing wound contraction. Inhibition of collagen synthesis, inhibition of cross-linking, or increased collagenolysis may eventually be clinically useful, and would be of value in controlling both contracture due to active wound contraction, and contracture due to passive positioning.

Keywords

Full Thickness Skin Biochemical Control Wound Contraction Scar Contracture Active Wound 

Résumé

La rétraction de la plaie est un mécanisme de base de la cicatrisation. Mais elle peut également produire d'importantes déformations dans des conditions diverses, telles que rétraction des brûlures, cirrhose, maladie de Dupuytren, rétraction autour des implants de silicone. Les données actuelles suggèrent qu'elle résulte de l'action de fibroblastes contractiles (myofibroblastes). Ces cellules ont, en microscopie électronique, une structure qui les apparente à la fois aux fibroblastes et aux cellules musculaires lisses. Aux points de vue pharmacologique et immunologique, le myofibroblaste présente de nombreux caractères de la cellule musculaire lisse. La rétraction active des plaies par les myofibroblastes peut être responsable de cicatrices fixées, rigides. Les contractures qui apparaissent au voisinage des articulations immobilisées en mauvaise position peuvent également être de cause passive, par réorganisation du collagène et sans participation des myofibroblastes. Trois types de traitement peuvent, en théorie, contrôler la rétraction et sont couramment utilisés: physiothérapie, y compris les exercises de mobilisation, pose d'attelles, greffe de peau totale après résection du tissu cicatriciel. La rétraction de la plaie peut également être diminuée par les substances qui agissent sur les fibroblastes en culture et qui réduisent la contractilité des myofibroblastes. Une inhibition de la synthèse du collagène et de ses liaisons, une collagènolyse accrue seront peut-être un jour utiles en clinique, pour contrôler à la fois la rétraction active de la plaie et la rétraction passive de position.

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Copyright information

© Société Internationale de Chirurgie 1980

Authors and Affiliations

  • Ross Rudolph
    • 1
  1. 1.Department of Surgery and Division of Plastic SurgeryUniversity of California, San Diego, and Veterans Administration HospitalLa JollaUSA

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