1 00:00:07,401 --> 00:00:11,408 The largest organ in your body isn't your liver or your brain. 2 00:00:11,408 --> 00:00:16,284 It's your skin, with a surface area of about 20 square feet in adults. 3 00:00:16,284 --> 00:00:19,420 Though different areas of the skin have different characteristics, 4 00:00:19,420 --> 00:00:22,035 much of this surface performs similar functions, 5 00:00:22,035 --> 00:00:26,152 such as sweating, feeling heat and cold, and growing hair. 6 00:00:26,152 --> 00:00:28,105 But after a deep cut or wound, 7 00:00:28,105 --> 00:00:31,746 the newly healed skin will look different from the surrounding area, 8 00:00:31,746 --> 00:00:36,481 and may not fully regain all its abilities for a while, or at all. 9 00:00:36,481 --> 00:00:41,097 To understand why this happens, we need to look at the structure of the human skin. 10 00:00:41,097 --> 00:00:43,045 The top layer, called the epidermis, 11 00:00:43,045 --> 00:00:47,219 consists mostly of hardened cells, called keratinocytes, 12 00:00:47,219 --> 00:00:49,135 and provides protection. 13 00:00:49,135 --> 00:00:52,192 Since its outer layer is constantly being shed and renewed, 14 00:00:52,192 --> 00:00:54,085 its pretty easy to repair. 15 00:00:54,085 --> 00:00:57,244 But sometimes a wound penetrates into the dermis, 16 00:00:57,244 --> 00:01:00,664 which contains blood vessels, and the various glands and nerve endings 17 00:01:00,664 --> 00:01:03,565 that enable the skin's many functions. 18 00:01:03,565 --> 00:01:06,753 And when that happens, it triggers the four overlapping stages 19 00:01:06,753 --> 00:01:09,798 of the regenerative process. 20 00:01:09,798 --> 00:01:14,840 The first stage, hemostasis, is the skin's response to two immediate threats: 21 00:01:14,840 --> 00:01:16,446 that you're now losing blood, 22 00:01:16,446 --> 00:01:20,256 and that the physical barrier of the epidermis has been compromised. 23 00:01:20,256 --> 00:01:23,007 As the blood vessels tighten to minimize the bleeding, 24 00:01:23,007 --> 00:01:25,258 in a process known as vasoconstriction, 25 00:01:25,258 --> 00:01:28,952 both threats are averted by forming a blood clot. 26 00:01:28,952 --> 00:01:33,140 A special protein known as fibrin forms crosslinks on the top of the skin, 27 00:01:33,140 --> 00:01:38,449 preventing blood from flowing out and bacteria or pathogens from getting in. 28 00:01:38,449 --> 00:01:41,902 After about three hours of this, the skin begins to turn red, 29 00:01:41,902 --> 00:01:44,828 signaling the next stage, inflammation. 30 00:01:44,828 --> 00:01:47,726 With bleeding under control and the barrier secured, 31 00:01:47,726 --> 00:01:52,079 the body sends special cells to fight any pathogens that may have gotten through. 32 00:01:52,079 --> 00:01:54,963 Among the most important of these are white blood cells, 33 00:01:54,963 --> 00:01:56,732 known as macrophages, 34 00:01:56,732 --> 00:02:02,004 which devour bacteria and damage tissue through a process known as phagocytosis, 35 00:02:02,004 --> 00:02:05,718 in addition to producing growth factors to spur healing. 36 00:02:05,718 --> 00:02:08,082 And because these tiny soldiers need to travel 37 00:02:08,082 --> 00:02:10,187 through the blood to get to the wound site, 38 00:02:10,187 --> 00:02:13,597 the previously constricted blood vessels now expand 39 00:02:13,597 --> 00:02:16,253 in a process called vasodilation. 40 00:02:16,253 --> 00:02:18,443 About two to three days after the wound, 41 00:02:18,443 --> 00:02:23,238 the proliferative stage occurs, when fibroblast cells begin to enter the wound. 42 00:02:23,238 --> 00:02:25,681 In the process of collagen deposition, 43 00:02:25,681 --> 00:02:29,749 they produce a fibrous protein called collagen in the wound site, 44 00:02:29,749 --> 00:02:33,934 forming connective skin tissue to replace the fibrin from before. 45 00:02:33,934 --> 00:02:37,717 As epidermal cells divide to reform the outer layer of skin, 46 00:02:37,717 --> 00:02:40,610 the dermis contracts to close the wound. 47 00:02:40,610 --> 00:02:43,217 Finally, in the fourth stage of remodeling, 48 00:02:43,217 --> 00:02:47,601 the wound matures as the newly deposited collagen is rearranged and converted 49 00:02:47,601 --> 00:02:49,428 into specific types. 50 00:02:49,428 --> 00:02:52,116 Through this process, which can take over a year, 51 00:02:52,116 --> 00:02:55,231 the tensile strength of the new skin is improved, 52 00:02:55,231 --> 00:02:58,639 and blood vessels and other connections are strengthened. 53 00:02:58,639 --> 00:03:02,104 With time, the new tissue can reach from 50-80% 54 00:03:02,104 --> 00:03:04,566 of some of its original healthy function, 55 00:03:04,566 --> 00:03:08,818 depending on the severity of the initial wound, and on the function itself. 56 00:03:08,818 --> 00:03:11,098 But because the skin does not fully recover, 57 00:03:11,098 --> 00:03:15,751 scarring continues to be a major clinical issue for doctors around the world. 58 00:03:15,751 --> 00:03:18,592 And even though researchers have made significant strides 59 00:03:18,592 --> 00:03:20,693 in understanding the healing process, 60 00:03:20,693 --> 00:03:23,871 many fundamental mysteries remain unresolved. 61 00:03:23,871 --> 00:03:27,453 For instance, do fibroblast cells arrive from the blood vessels, 62 00:03:27,453 --> 00:03:30,039 or from skin tissue adjacent to the wound? 63 00:03:30,039 --> 00:03:32,619 And why do some other mammals, such as deer, 64 00:03:32,619 --> 00:03:37,296 heal their wounds much more efficiently and completely than humans? 65 00:03:37,296 --> 00:03:39,831 By finding the answers to these questions and others, 66 00:03:39,831 --> 00:03:44,794 we may one day be able to heal ourselves so well, that scars will be just a memory.