Wound healing is the process by which a complex cascade of biochemical events is responsible of
the repair the damage. In vivo, studies in humans and mice suggest that healing and post-healing heterogeneous
behavior of the surgically wounded myometrium is both phenotype and genotype dependent. Uterine
wound healing process involves many cells: endothelial cells, neutrophils, monocytes/macrophages, lymphocytes,
fibroblasts, myometrial cells as well a stem cell population found in the myometrium, myoSP (side
population of myometrial cells).
Transforming growth factor beta (TGF-β) isoforms, connective tissue growth factor (CTGF), basic fibroblast
growth factor (bFGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF),
and tumor necrosis factor alpha (TNF-α) are involved in the wound healing mechanisms. The increased TGF-
β1/β3 ratio reduces scarring and fibrosis. The CTGF altered expression may be a factor involved in the abnormal
scars formation of low uterine segment after cesarean section and of the formation of uterine dehiscence.
The lack of bFGF is involved in the reduction of collagen deposition in the wound site and thicker
scabs. The altered expression of TNF-α, VEGF, and PDGF in human myometrial smooth muscle cells in case
of uterine dehiscence, it is implicated in the uterine healing process.
The over-and under-expressions of growth factors genes involved in uterine scarring process could represent
patient’s specific features, increasing the risk of cesarean scar complications.