Chapter 51 - Differences in Foetal, Adult Skin and Mucosal Repair

Abstract

Scar formation, a physiologic process in adult wound healing, can have devastating effects for patients; a multitude of pathologic outcomes, affecting all organ systems, stems from an amplification of this process. In contrast to adult wound repair, the early gestation fetal skin wound heals without scar formation, a phenomenon that appears to be intrinsic to fetal skin. Interestingly, there is strong evidence to suggest healing of oral mucosal wounds parallels that of fetal skin wound repair, and that the relative scarless repair of oral mucosa is also derived primarily from the intrinsic differences in oral mucosal tissue, rather than from the intraoral environment. An intensive research effort has focused on unraveling the mechanisms that underlie scarless fetal wound healing in an attempt to improve the quality of healing in both children and adults. Unique properties of fetal skin and oral mucosal cells, extracellular matrix, cytokine profile, and gene expression contribute to this scarless repair. Despite the great increase in knowledge gained over the past decades, the precise mechanisms regulating scarless wound healing remain unknown. Herein, we describe the current models and proposed mechanisms underlying scarless wound healing in an effort to better understand this privileged phenotype.