Skin, fascias, and scars: symptoms and systemic connections

Abstract

Every element or cell in the human body produces substances that communicate and respond in an autocrine or paracrine mode, consequently affecting organs and structures that are seemingly far from each other. The same also applies to the skin. In fact, when the integrity of the skin has been altered, or when its healing process is disturbed, it becomes a source of symptoms that are not merely cutaneous. The skin is an organ, and similar to any other structure, it has different functions in addition to connections with the central and peripheral nervous system. This article examines pathological responses produced by scars, analyzing definitions and differences. At the same time, it considers the subcutaneous fascias, as this connective structure is altered when there is a discontinuous cutaneous surface. The consequence is an ample symptomatology, which is not limited to the body area where the scar is located, such as a postural or trigeminal disorder.

Keywords: fascia; osteopathic; scar; scarring; skin.

Figure 1

Transverse section at the level of the upper third of the leg. The fascia is the philosophy of the body, meaning each body region is connected to another, whereas osteopathy is the philosophy of medicine: the entire human body must work in harmony. Reproduced with permission anastasi et al. AA VV, anatomia dell’uomo, 4 ed, Edi.ermes, Milano [Human anatomy]. Notes: 1, tibia; 2, muscular loggia; 3, interosseous membrane; 4, fibula; 5, intermuscular septum. All tissues are enveloped by fascial continuity.

Figure 2

The photo shows atrophic scar on the shoulder. Note: The atrophic scar appears as a cutaneous depression.

Figure 3

Intervention of sternotomy after cardiac surgery. There is a high percentage of risk that the scar could develop into a pathological scar. Note: When the dermis and the fascia are affected by scars, these structures are altered, and their function and capacity of interaction with the external and internal environment are lacking.

Figure 4

General organization and territories of innervation of the sympathetic nervous system (blue) and parasympathetic nervous system (red). We can logically assume that in the presence of a scar, these receptors may experience an alteration, resulting in transmitting nonphysiological signals and creating a pathological reflex arc. Reproduced with permission Anastasi et al. AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes, Milano [Human Anatomy]. Notes: 1, eye; 2, lacrimal gland; 3, submandibular gland; 4, sublingual gland; 5, parotid gland; 6, vessels; 7, heart; 8, lungs; 9, abdominal vessels; 10, stomach; 11, liver; 12, pancreas; 13, small intestine; 14, adrenal gland; 15, kidney; 16, large intestine; 17, urinary bladder; 18, genital apparatus; 19, superior cervical ganglion; 20, cervical ganglion medium; 21, inferior cervical ganglion; 22, celiac ganglion; 23, superior mesenteric ganglion; 24, inferior mesenteric ganglion; 25, brown adipose tissue; 26, hair follicles; 27, blood vessels; 28, sweat glands; 29, bulb; 30, bridge; 31 midbrain.

Figure 5

The structures of the spinal cord and blood vessels, rear projection, are made up of various layers but are continuous. However, it is usually ignored when the tissue where the tension is observable is in an unbalanced condition, as in the case when a scar is present, the cells cannot properly interpret the message, giving consequent anomalous responses. Reproduced with permission Anastasi et al. AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes, Milano [Human anatomy]. Notes: 1, superior articular process; 2, inferior articular process; 3, subdural space; 4, septum posterior; 5, upper spinal vessels; 6, subarachnoid space; 7, spinous process; 8, posterior lateral sulcus; 9, posterior median sulcus; 10, anterior root motor; 11, sensory posterior root; 12, interradicular septum; 13, denticulate ligament; 14, spinal pia mater; 15, spinal arachnoid; 16, spinal dura mater; 17, the anterior branch of the spinal nerv; 18, posterior branch of the spinal nerve; 19, spinal vertebral artery branch; 20, spinal ganglion; 21, branches of the spinal vertebral vein; 22, posterior internal vertebral venous plexus; 23, epidural fat; 24, epidural space.

Figure 6

Fascias of the neck. Deep traumas can also affect the fascia and the viscera, which then go through an identical healing process. Reproduced with permission Anastasi et al. AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes, Milano [Human anatomy]. Notes: 1, parotid fascia, masseteric fascia; 2, platysma; 3, submandibular gland; 4, external jugular vein; 5, laryngeal prominence; 6, superficial cervical fascia; 7, anterior jugular vein; 8, the jugular venous arch; 9, middle cervical fascia; 10, clavicle; 11, superficial cervical fascia; 12, trapezius muscle; 13, sternocleidomastoid muscle; 14, occipital muscle (of the epicranic muscle); 15, esophagus; 16, deep cervical fascia; 17, carotid sheath; 18, common carotid arter; 19, internal jugular vein; 20, chain of the sympathetic nervous system; 21, 6° cervical vertebrae, anterior tubercle; 22, 6° cervical vertebrae, transverse process; 23, 6° cervical vertebrae, posterior tubercle; 24, levator scapula, 25, nuchal’s fascia; 26, nuchal ligament; 27, semispinalis muscle of the head and neck; 28, splenius muscle of head and neck; 29, multifidus muscle of the neck; 30, posterior scalene muscle; 31, middle scalene muscle; 32, vertebral artery; 33, anterior scalene muscle; 34, long muscle of the neck; 35, phrenic nerve; 36, inferior constrictor muscle of the pharynx, cricopharyngeal portion; 37, sternocleidomastoid muscle; 38, trachea; 39, omohyoid muscle; 40, platysma; 41, muscle sternothyroidean; 42, muscle sternohyoidean.

Figure 7

A surgery to remove the radial artery. Furthermore, the fascial tissue is made of contractile fibers, which may possibly produce spasms and consequential dysfunction and pain.

Figure 8

Continuity from the pelvis to the sternum. Muscles of the anterior wall of the trunk; view from inside. In addition, we can assume a malfunction of the respiratory diaphragm because of the stiffening of the lumbodorsal spine, to which the primary muscle of respiration is closely connected. Reproduced with permission Anastasi et al. AA VV, Anatomia dell’uomo, 4 ed, Edi.ermes, Milano [Human Anatomy]. Notes: 1, sternum; 2, first rib; 3, internal intercostal muscle; 4, sternal part of the diaphragm; 5, sternocostal trigon; 6, costal part of the diaphragm; 7, tendinous sign of the rectus abdominis muscle; 8, transversus abdominis muscle; 9, arcuate line; 10, inguinal ligament; 11, spermatic cord; 12, iliopsoas muscle; 13, the femoral vessels; 14, deep inguinal ring; 15, semilunar line; 16, umbilicus; 17, linea alba; 18, transverse muscle of the chest.