ABSTRACT
Observation of healing wounds, created either by trauma or elective surgery, demonstrates that scars which are parallel to flexion creases generally heal without hypertrophy, whereas those that cross flexion creases have a tendency to hypertrophy (see Figure 2A). Some anatomical areas are protected from lengthwise stretching owing to an underlying structure, such as the palmar fascia, as can be seen in Figure 1. The portion of the scar that overlies the fascia does not elongate and contract with wrist movement and does not hypertrophy. However, the portion of the scar that overlies the more supple volar forearm tissues is not protected from such forces and does hypertrophy.
