CLASS V. – NEW-GROWTHS
Definition. – A new connective tissue formation which results from the process of healing, following loss of substance.
Symptoms and Etiology. – Scars correspond in a large degree in their shape and depth to the breaks left in the surface after wounds and diseases have healed. They may, therefore, be regular or irregular, small or large, flat or depressed. Small superficial scars may almost disappear in time leaving only delicate lines or dots, while deep scars are permanent though they may shrink to small dimensions. Burns are apt to leave uncomfortable and disfiguring scars. In color any scar is at first pink, owing to the abundance of blood vessels and the thinness of the epidermic covering, but they all have a tendency to shrink and as the blood vessels slowly disappear the color gradually becomes a shining white. Old scars may even show considerable pigment. The typical simple or normal scar is flat or only slightly sunken but atrophic scars such as may follow the pustules of variola, sycosis or acne varioliformis are considerably depressed. On the other hand scar tissue formation may not cease at the point of proper contact but continue to develop, resulting in a hypertrophic scar.
Pathology. – The formation of a scar is essentially a connective tissue development presenting interlacing bundles with an absence of glands, follicles, hairs and furrows. Granulations tissue composed of loops of capillaries surrounded by multitudes of round cells is an active factor in the early state of scar formation. Gradually this granulation stage is transformed into fibrous cicatricial tissue with a lessening of even an obliteration of the blood vessels.
Diagnostic Significance of Scar. – The nature of the previous pathological process may sometimes be surmised by the appearance of cicatrices. Scrofulous ulcerations of the skin usually leave disfiguring, linear or irregular and often extensive scars. Lupus cicatrices may also be irregular or uneven and disfiguring though usually they are superficial. The scars from syphilis are often delicate and smooth, slightly depressed, sharply defined but vary in shape, depth and extent, and not for a time they have a typical reddish pigmentation.
Prognosis and Treatment. – Scars are permanent although time and sensible treatment may improve their appearance, lessen contractions or prevent deformity. Much more may be done, therapeutically, especially for scars in conspicuous locations that is ordinarily supposed. Persistent hyperemia is the first step and this may be accomplished by the application of Bier’s suction cup daily or the local use of the high-frequency currents. Injections of fibrolysin (thiosinamin) every three or four days, into portions of the body apart from the scar, or solutions of the same substance or 2 per cent. sodium chlorid may be applied by cataphoresis directly into the scar tissue. Repeated small doses of the X-rays have produced softer, thinner scars, especially those of smallpox, chicken-pox and acne, but the danger of developing telangiectases must be borne in mind. If the latter do arise, they may be destroyed by electrolysis. Skin grafting may be indicated or other surgical measures employed to prevent adhesions and contractions. To remove exuberant granulations ordinary caustics or preferably solidified carbon dioxid may be used. Among the remedies suitable to act on scar tissue are Calcarea flour., Fluor. acid and Graphites.