Collagen and dermal patterns in the hypertrophic scar

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Abstract
Hypertrophic scar, mature scar, normal skin and granulation tissue were studied by transmission (TEM) and scanning (SEM) electron microscopy for characteristics and differences in fine structure, especially the collagen filaments and their physical association with each other and with interstitial components of the ground matrix.The shape of the collagen filaments is irregular and angular in granulation tissue, irregular to ovoid in hypertrophic scar, ovoid to round in mature scar, and round in normal skin. The mean diameter of the collagen filaments measures approximately 440 Å in granulation tissue, 600 Å in hypertrophic scar, 1000 Å in mature scar, and 1050 Å in normal skin.Interstitial filaments are prominent in hypertrophic scar by TEM. In nodular areas where collagen is examined in cross section the interstitial filaments often appear to interconnect long chains of collagen filaments. The interstitial filaments are not observed by SEM. Rather, by this method of observation, the demis of hypertrophic scar is seen as a homogeneous matrix, and individual collagen filaments are not observed.It is suggested that the hypertrophic scar is characterized by an unusually firm intercollagen binding by interstitial filaments, which are probably protein‐polysaccharides of the ground matrix. This relationship could account for the clinical quality of extreme hardness of the scar, and might also suggest an aberration important in the etiology of the scar.