The remolding or scar maturation phase officially begins about 3 weeks after the injury and persists for months to years. The wound remolding is the result of increasing cross-linking, resulting in increased strength. Collagenase beings by breaking down excess collagen accumulation. There is a regression of the extensive content decreases as does the wound water content.

• Increasing collagen cross-linking increases strength

• Breaking down excess collagen by collagenase 
• Regression of granulation tissue and the return of normal blood flow
• Decrease in interstitial cement makes wound more supple 

The loss of wound blood flow or addition of infection, however, can lead to a net increase in collagen loss resulting in a weakened wound. In general, wound strength continues to increase even beyond a year. Skin and fascia never do regain full strength.

The excessive deposition of scar can occur leading to hypertrophic or excessive scar formation which will impede tissue movement and usually results in a friable wound with pain on movement. Keloids is an excess in connective tissue formation. Excess collagenolysis can also weaken the wound possibly causing dehiscence.

Impairment:

• Excessive scar

• Weakening scar

1. Collagenolysis

2. Malnutrition

3. Decreased anabolism

Excessive Scar Tissue