Figure 3. The ‘scarring cycle’ schematized.

Hypertrophic scars are regenerated from a persistence of the tissue replacement phase, in the absence of ‘stop signals’ such as ligands for CXCR3 or angiopoietins even after full re-epithelialization and seeming ‘wound closure’ (right arm). This hypercellularity with active matrix turnover re-initiates an chronic inflammatory milieu which in turns drive more immature matrix production, eventually leading to excessive but poorly functional fibrillar collagen. Adapted from ref 10.