**3. Scarless wound healing**

While scars are revered in some cultures, with elaborate rituals centred around developing aesthetically pleasing, elaborate scars, they are more commonly categorised as a cosmetic concern. Apart from aesthetic concerns, scars can also lead to reduced functionality and limit mobility. Furthermore, unsightly scars, particularly those on the face or other visible areas of the body; can often lead to crippling self-esteem issues and affect the quality of life of the effected individual. The United States of America alone has a \$12 million industry targeted to reducing or limiting scars [8, 10].

Scarless wound healing as it occurs in nature is a rare phenomenon that is limited to specific scenarios.

#### **3.1 Foetal wound healing**

While wounds in the early mammalian gestational period heal without the formation of scars, wounds beyond that period form scars. It has been speculated that the early foetal wound healing occurs by a process resembling regeneration. While the exact mechanism is elusive, it is speculated that the characteristics that differentiate foetal skin at the tissue and cellular levels plays a role such as the decreased tensile strength [11].

A fascinating study by Wong et al. [13] has connected mechano-transduction with fibrosis through the focal adhesion kinase (FAK) pathway. It was observed that the extra cellular-related kinase (ERK) initiated the secretion of monocyte chemoattractant protein-1(MCP-1) in the FAK pathway is associated with multiple fibrotic disorders in humans. When components of the inflammatory FAK-ERK-MCP-1 pathways are inhibited, the development of scars is attenuated [13].

#### **3.2 Oral mucosa**

In the mammalian system, the oral mucosa demonstrates minimal scarring and is the closest model of regenerative healing. It is often described as a 'protected environment' for wound healing as the underlying mucosa in the oral cavity is protected from mechanical damage or infection from pathogens by hydrophilic viscoelastic gels that

### *Scarless Wound Healing DOI: http://dx.doi.org/10.5772/intechopen.105618*

are formed by the salivary mucins [14]. Fascinatingly, they lose this property when transplanted [15].

Studies comparing the oral mucosa to the foetal wound healing environment have found similarities in the ECM with the mucosa revealing increased fibronectin, its splice variant ED-A and chondroitin sulphate as compared to the skin. Also, elastin levels were found to be higher in dermal cells, with those exhibiting greater differentiation property as opposed to the greater proliferative property demonstrated by the mucosa [16].
