Fisiología de la Cicatrización, Remodelacion (Maduracion)

Colágeno

El contenido de colágeno aumenta rápidamente durante las 3 primeras semanas y al acumularse 7 mg/mL debe obtenerse un equilibrio entre producción y destrucción (104).

A medida que madure la cicatriz, se van reponiendo fibras y éstas son sometidas a movimiento, presión y otros factores mecánicos que ayudan a orientarlas siguiendo las líneas de tensión de la piel (2). Con el transcurso del tiempo se observa disminución celular y se atrofian los capilares neo formados, por lo que el área palidece (35).

En el espacio extracelular decrece la concentración de ácido hialurónico que es remplazado por proteoglicanes más elasticos, como el condroitin-4-sulfato; se reabsorbe el agua y las fibras se juntan, con lo cual se aplana la región. El colágeno tipo III gradualmente es remplazado por el 1, hasta obtener el promedio normal de 1: 4.

No está bien establecido el papel que desempeñan las glucoproteínas y los mucopolisacáridos o proteoglicanes, pero es posible que ayuden a organizar el colágeno y que determinen (según sea el que predomine) el tamaño, la rigidez y otras cualidades físicas de las nuevas moléculas (7, 105).

También es probable que las fuerzas que se ejercen sobre los tejidos produzcan cargas eléctricas que facilitan la orientación, especialmente cuando se interdigitan con proteoglicanes (5).

La colagenólisis juega un papel fundamental durante la remodelación ya que elimina las fibras iniciales depositadas de manera desorganizada, facilitando su remplazo por otras mejor orientadas y más resistentes, ayudando a formar una cicatriz más estable (5).

Durante este período se ha demostrado fagocitosis de colágeno por los fibroblastos (106). Al momento de retirar las suturas, la herida sólo posee el 3% de la fuerza tensil normal; a las 4 semanas aumenta a un 30%, pero nunca sobrepasa el 80% (107.

Lea También: Biología y Bioquímica de la Cicatrización de las Heridas

Abstract 

The ability to heal wounds by lorming scar tissue is essentiallor the survival of all higher species. Wounds can be lilethreatening, commonly affect functional ability, and virtua11yalways compromise appearance.

Over the past five years there has been renewed interest in the basic components of wound healing and how they interact with each other. The surgeon, perhaps more than any other physician, should have an in-depth knowledge of this processes il he or she is to wisely treat his or her patients.

This article updates present Knowledge of the mechanisms involved in tissue repair, such as: inflammation, epithelization, contraction, neovascular growth, collagenproduction and lysis and maturation. 

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Doctor Alberto Kurzer Schall, Jefe de la Sección de Cirugía a Plástica, Maxilofacial y de la Mano, U. de Antioquia, Hosp. Universitario San Vicente de Paúl Medellín, Colombia.