Pathological scarring imposes a major clinical and social burden worldwide. Human cutaneous wounds are responsive to mechanical forces and convert mechanical cues to biochemical signals that eventually promote scarring. To understand the mechanotransduction pathways in cutaneous scarring and develop new mechanotherapy approaches to achieve optimal scarring, the current study highlights the mechanical behavior of unwounded and scarred skin as well as intra- and extracellular mechanisms behind keloid and hypertrophic scars. Additionally, the therapeutic interventions that promote optimal scar healing by mechanical means at the molecular, cellular or tissue level are extensively reviewed. The current literature highlights the significant role of fibroblasts in wound contraction and scar formation via differentiation into myofibroblasts. Thus, understanding myofibroblasts and their responses to mechanical loading allows the development of new scar therapeutics. A review of the current clinical and preclinical studies suggests that existing treatment strategies only reduce scarring on a small scale after wound closure and result in poor functional and aesthetic outcomes. Therefore, the perspective of mechanotherapies needs to consider the application of both mechanical forces and biochemical cues to achieve optimal scarring. Moreover, early intervention is critical in wound management; thus, mechanoregulation should be conducted during the healing process to avoid scar maturation. Future studies should either consider combining mechanical loading (pressure) therapies with tension offloading approaches for scar management or developing more effective early therapies based on contraction-blocking biomaterials for the prevention of pathological scarring.

中文翻译：

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皮肤生物力学：减少疤痕的潜在治疗干预目标


病理性疤痕给全世界带来了重大的临床和社会负担。人体皮肤伤口对机械力有反应，并将机械信号转化为生化信号，最终促进疤痕形成。为了了解皮肤疤痕中的机械传导途径并开发新的机械治疗方法以实现最佳疤痕形成，当前的研究强调了未受伤和疤痕皮肤的机械行为以及疤痕疙瘩和肥厚性疤痕背后的细胞内和细胞外机制。此外，还广泛回顾了在分子、细胞或组织水平上通过机械手段促进最佳疤痕愈合的治疗干预措施。目前的文献强调了成纤维细胞通过分化为肌成纤维细胞在伤口收缩和疤痕形成中的重要作用。因此，了解肌成纤维细胞及其对机械负荷的反应有助于开发新的疤痕疗法。对当前临床和临床前研究的回顾表明，现有的治疗策略只能在伤口闭合后小范围减少疤痕，并导致功能和美观结果不佳。因此，机械疗法的角度需要考虑机械力和生化信号的应用，以实现最佳的疤痕形成。此外，早期干预对于伤口处理至关重要。因此，在愈合过程中应进行机械调节以避免疤痕成熟。未来的研究应该考虑将机械负荷（压力）疗法与张力卸载方法相结合来进行疤痕管理，或者开发基于收缩阻断生物材料的更有效的早期疗法来预防病理性疤痕。