Mechanical analysis of hypertrophic scar tissue: structural basis for apparent increased rigidity.

The mechanical behavior of normal human skin and hypertrophic scar tissue (HST) is compared using constant-strain-rate and successive stress-relaxation uniaxial loading programs in vitro. HST is less extensible, requires more energy to be stretched in the physiologic range, and stores strain energy less efficiently than normal skin. The explanations for the differences observed between the mechanical behavior of normal skin and HST are based on the differences in their composition and structure. We suggest that the collagen fiber network is partially "prealigned" in a crimped tendon-like organization in HST, which reduces its extensibility and raises the strain energy required to stretch it. It is further hypothesized that an incomplete elastic fiber network, an abnormal glycosaminoglycan content, and/or abnormal collagen fiber slippage are responsible for the reduced capacity to return strain energy in the hypertrophic scar tissue. The results of these studies indicate that although HST has been described as stiffer than normal skin, the maximum stiffness of skin and HST are similar. The "apparent" increased rigidity of HST is a result of reduced extensibility rather than a change in its stiffness. This inexensibility may manifest itself by limiting joint mobility in the patient with HST.