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Hypertrophic scars, mature scars from hypertrophic and non-hypertrophic healing, and normal skin have been examined by biopsy and studied for histological patterns consistent with each case. Normal skin presents collagen appearing randomly of oriented and with a marked waviness. Under stress the collagen reflect, a previously masked orthogonal ply pattern. The hypertrophic scar may be characterized by a consistent pattern of collagen, which is never found in normal skin of a mature scar. This pattern, consistent with the most active stage of hypertrophy, contain nodules of collagen. They are highly compact, often with a capsule-like band about their periphery. Blood vessels are frequently observed about the periphery. The early stage ot hypertrophic scarring displays bundles ox tracts in curvilinear form, several of which together demonstrate a whorl-like arrangement. Whether or not the whorl arrangements proceed to form a nodule or bypass this stage to begin maturation is dependent on unknown factors. By electron microscopy, the nodule is seen to contain highly stellate fibroblasts with dilated rough endoplasmic reticulum and few other organelles. The diameter of the collagen filaments is about half that observed in normal skin. We conclude that hypertrophic scarring involves the formation of collagenous nodules composed of tightly packed collagen. Nodular formation appears to reflect the most active and the worst phase of hypertrophic scarring. [ABSTRACT FROM AUTHOR]