Sisi’s surgery was highly successful, not only did it result in no scars, but the skin’s color gradually matched the surrounding skin, even the texture appeared natural and harmonious, making it impossible to tell by the naked eye that she had undergone surgery.
The lecture hall of the international conference center at Sanbo Hospital was already filled with three hundred seats occupied. People stood in the corridors, sat on the steps at the back, and even the entrance was crowded with young doctors holding notebooks. This was not an ordinary academic lecture, the na on the poster had everyone eagerly anticipating: Ivan Kovalenko, the magician of plastic surgery, but more importantly, the subtitle on the poster read: "Scar Prevention and Treatnt Techniques Based on Three-Dinsional Gene Theory: From Macroscopic Surgery to Microscopic Regulation."
This was Ivan’s first public, systematic exposition of his achievents. In the past few years, he had sporadically ntioned these concepts at conferences worldwide, but had never presented them in full. This ti, he chose Sanbo, in Yang Ping’s territory, to showcase his latest theory, the purpose being to pay tribute to Professor Yang Ping.
Sisi sat in the third row, the scar on her right thigh had faded to almost invisible. She was no longer a patient, but an audience mber, her notebook filled with densely written preparation questions: on the regulation of fibroblast behavior, the relationship between tension and collagen alignnt, and the technology she had personally experienced, soon to be unveiled.
Yang Ping sat at the edge of the first row, not the center position. He insisted on this; today’s main character was Ivan. However, his presence was an endorsent, a silent confirmation of the theory’s effectiveness.
At 9 a.m., Ivan stepped onto the podium. He wasn’t wearing a suit, just a simple light blue shirt. He turned on the projector, the first slide was not a title, but a photo: a before-and-after comparison of Sisi’s right thigh. Not an ordinary photo, but a high-definition image showing skin texture.
"This is my business card," he said in Chinese, with a slight accent, "not in words, but in images."
He clicked to the next slide, which was a cell microscopic photo.
"Let’s start from the basics," Ivan said, his voice becoming deep and clear, "What is a scar?"
The slide displayed two lines:
Scar: The product of repair by fibrous connective tissue after tissue injury
Normal healing: Complete replacent by the sa cell type with no structural change.
"To put it simply, the most ideal normal healing would have the damaged area completely repaired by the original cells. A scar, on the other hand, is the replacent of original cells by fibrous connective tissue during repair."
"The key difference is not whether there is repair, but what is used for repair,"
Ivan demonstrated the deanor of a master, fluent and mature in Chinese.
"Normal healing involves the original cells participating in repair, fully restoring structure and function. Scar healing involves excessive fibroblast proliferation, secreting disorderly arranged collagen fibers, forming tissue lacking normal skin appendages, abnormal elasticity and tension."
He presented a histological comparison image: on the left, normal skin collagen fibers arranged in a regular wavy pattern, interwoven into a network; on the right, scar tissue collagen fibers were thick, straight, aligned parallel, like randomly piled steel bars.
"Look at this image," he pointed to the normal skin, "the direction of collagen fibers aligns with the skin surface tension lines (Langer’s lines). This arrangent is not random; it results from cells ’knowing’ the direction in which they should align. In scars," he pointed to the right side, "this ’knowledge’ is lost. Fibroblasts blindly accumulate collagen, disregarding direction, tension, or function."
A young resident raised a hand: "Professor Ivan, is this ’knowledge’ a chanical signal or a chemical signal?"
"Good question," Ivan said, "It’s both, but the key lies in their integration. Traditional theories emphasize the regulation of collagen synthesis by growth factors like TGF-β, which is important but insufficient. Professor Yang’s three-dinsional gene theory tells us that cells not only need to be ’told what to synthesize,’ but ’where to synthesize and in what spatial direction to align.’"
He clicked to the next page, showing a complex signal pathway diagram.
"This is the Wnt/β-catenin pathway, a classic morphogenetic signal. But Professor Yang’s contribution is the discovery that the spatial dinsion gradient distribution of this pathway determines the cell’s ’positional identity.’ During embryonic developnt, this identity tells cells what to differentiate into; in adult tissues, maintaining this identity allows skin, bones, and nerves to maintain normal structure; in damage repair, the loss of this identity leads to scar formation."
Sisi quickly took notes. She had read about this in literature, but Ivan’s explanation made it vivid. She thought of her own scar, recalling Ivan’s words during surgery about ’map rewriting,’ he wasn’t taphorically speaking, but describing a real biological process.
"Now, let’s talk about scar classification and evaluation," Ivan said, "Although this knowledge may seem simple and dry, not grand at all, correct treatnt begins with correct diagnosis."
Slide transition:
Superficial scars: Only affecting the epidermis or superficial dermis, flat, soft, pignted or depignted.
Hypertrophic scars: Affecting deep dermis, red, raised, itchy, but not exceeding the original injury boundary.
Keloids: Invading surrounding normal skin, extending beyond the original injury boundary, continuous growth, high recurrence rate.
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