29/12/2025
Even with major advances in modern medicine and wound care, burn survivors and other patients with extensive injuries often develop thicker scar areas or contracture lines, and their location is far from random.
These problematic areas consistently appear in locations exposed to the greatest range of motion: the neck, shoulders, elbows, underarms, and finger web-spaces.
These are areas where skin must accommodate three-dimensional movement across joints and within the body's kinetic chain of motion. The same pattern appears in keloid scar development.
Regardless of what triggers the increased tension or contracture, the result is a shortage of tissue.
The scar quality becomes poor, often featuring either a very thin, fragile outer layer or a thickened, rough surface sitting atop dense, thickened deeper tissue.
This pattern makes sense when you consider the dermis's function: providing durability, strength, elasticity, temperature regulation, and sensation.
When scar tissue is constantly under movement and tension, the dermis appears to respond by thickening during the scar maturation process, a natural attempt to maintain its protective and structural functions despite the tissue shortage and constant mechanical stress.
Understanding this mechanical basis for scar thickening in movement-prone areas helps explain why some scars remain problematic and why interventions targeting mechanical forces can be so effective in managing these challenging cases.
