Cicatrix

“ When the adhesion is complete between all the cells that first form the fleshy granulations, the membrane of the cicatrix, the result of this adhesion, exists. Thus it is that all the flesh, the development of which astonishes us, and which amply repairs the loss of substance, is but a pellicle, reddish when the exhalants are full of blood, but afterwards white by the return of this blood into its vessels.
From this mode of origin of external cicatrices, it is easy to conceive, 1st. why they adhere intimately to the places in which they are found, and have no laxity in the integuments ”

“ As soon as the ulcer assumes the characters of a healing sore, it should be covered with skin-grafts, which furnish a much better cicatrix than that which forms when the ulcer is allowed to heal without such aid. ”

“ The left side of the face is wider than the right side, the left malar bone being more prominent than its fellow. There is a linear cicatrix near the angle of the lower jaw, an inch in length. Ptosis of the left eyelid; the globe considerably more prominent than its fellow, but not as large as when I last saw him. Can adduct and depress the globe, but cannot move it in other directions; vision lost. A linear cicatrix, length two and one-half inches, from the nasal protuberance to the anterior edge of the raised fragment of the frontal bone, is quite unsightly. ”

“ Sloughing Due to Pressure.—When an injection is forced into a dense or firmly bound-down tissue, as into the body of a thickened cicatrix, or about the point of the nose or the subseptum of the nose without first dissecting off the skin above the subcutaneous layers, an acute anemia is at once marked, followed by inflammation and gangrene. ”

“ It is most suitable in cases of anchylosis, where there is little deposit of new bone, or in cases of disease of the joint, accompanied with little swelling or thickening of surrounding tissues. It has the advantage of avoiding the cicatrix of a transverse incision, which doubtless may, if at all a broad one, somewhat interfere with the future flexion of the limb, but, on the other hand, unless care is taken, it does not give such free egress for the discharge, and when there is much delay in healing, the vertical incision may leave a cicatrix nearly as troublesome as the other. ”

“ In 32,052 autopsies made in Prague, Berlin, Dresden, Erlangen, and Kiel,9 there were found 1522 cases of open ulcer or of cicatrix in the stomach. If all the scars be reckoned as healed ulcers, according to these statistics gastric ulcer, either cicatrized or open, is found in about 5 per cent. of persons dying from all causes. ”

“ The lobule of the ear thus adhesioned should be gradually pulled down and elongated after the complete healing of the local ulcer and the subsidence of its concomitant symptoms, and after the cicatrix has assumed the colour of the skin of the surrounding part. Otherwise the adhesioned part may be characterised by pain, swelling, inflammation, burning and suppuration, or the adhesion may again fall off. ”

“ They grow until they reach the level of the surrounding skin, and so fill the gap with a fine velvety mass of granulation tissue. At the edges, the young epithelium may be seen spreading in over the granulations as a fine bluish-white pellicle, which gradually covers the sore, becoming paler in colour as it thickens, and eventually forming the smooth, non-vascular covering of the cicatrix. ”

“ The only objection to their use is the cicatrix which they leave, and which, in certain situations, we would wish to avoid. When the tumor is thickly covered with the integuments, the issue may be made directly over it, by means of a blister, kept open by savine ointment98, or any other irritating preparation; but, when the tumor is thinly covered, this will not succeed, as the inflammation consequent to the insertion of the issue will be communicated to the gland which is in immediate contact with the ulcerated surface. ”

“ The cicatrix begins to be painful, and inflammation spreads around. The absorbents are called into more powerful action; they begin to attack the virus itself, and a portion of it is taken up, and carried into the circulation, and acquires the property of assimilating other secretions to its own nature, or it is determined to one of the secretions only; it alters the character of that secretion, envenoms it, and gives it the power of propagating the disease. ”

“ In case the entropion is caused by an old standing cicatrix, it may be necessary, first, to make a careful incision along the edge of the lid so as to separate the tarsus and conjunctiva from the cilia and Meibomian ducts, and then to proceed with the plastic operation on the skin.
TURNING OUT OF THE EYELID. ECTROPION. In large dogs, in old age, debility, conjunctival swelling, cicatrized skin of lids, distortions of lids. ”

“ It is especially in these cases that a filtrating cicatrix, which sometimes follows iridectomy or sclerotomy, is desirable, and indeed some surgeons (Herbert and Lagrange, see p. 231) , have recently performed operations with this idea in view, and it is probable that this operation or cyclo-dialysis will prove to be of use in these cases. ”

“ Cicada, si-kā′da, Cicala, si-kā′la, n. an insect remarkable for its chirping sound. [L. cicada.]
Cicatrix, sik-ā′triks, or sik′a-triks, n. the scar over a wound after it is healed—also Cic′atrice: scar in the bark of a tree: (Shak.) mark, impression.—ns. Cicatric′ula, the germinating point in the yolk of an egg; Cicatrisā′tion, the process of healing over.—v.t. Cic′atrise, to help the formation of a cicatrix on a wound or ulcer: to scar.—v.i. to heal. [Fr.,—L. cicatrix, a scar.]
Cicely, sis′e-li, n. a genus of umbelliferous plants nearly allied to chervil. [L. and Gr. seseli.] ”

“ The ulcer may involve the circumference of the bowel, and the resulting cicatrix terminate in uniform constriction of its lumen, or the ulceration may extend several inches along the side of the intestine, ultimately causing contraction in the direction of its longitudinal axis, marked stenosis, and kinking of the gut. When ulceration, continuous or in patches, involves a large extent of bowel, it may reduce the gut to a mass of indistinguishable cicatricial tissue. ”

“ In cases of severer form the cicatrix is removed by an elliptical incision, the lip returned to its natural position, and a pedunculated flap of skin is taken up from the chin or the cheek which is rotated into the wound, or a skin graft is implanted into the area by the Wölfler method and sutured to the free margins of the skin, or the Thiersch method may be employed. ”

“ Thus, scrophula is marked by a particular appearance of the cicatrix, or of the scab. The venereal ulcer has likewise a particular scab, and many cutaneous ulcers are best distinguished by the scab. Other actions produce no considerable ulceration, but only successive desquamation of the cuticle.
We may also sometimes discover specific action by the sensation of which the action is productive. Thus, for instance, cancer produces a burning kind of pain, which never attends simple ulceration. ”

“ After the ulcer has healed, the patient should wear in his boot a thick felt sole with a hole cut out opposite the situation of the cicatrix. When a joint has been opened into, the difficulty of thoroughly getting rid of all unhealthy and infected granulations is so great that amputation may be advisable, but it is to be remembered that ulceration may recur in the stump if pressure is put upon it. ”

“ In the deeper portions of the tracks the extreme density of the cicatrix is a factor of great prognostic importance, since if it implicates muscles, tendons, vessels, or nerves, impairment of movement, circulatory disturbance, or signs of neuritis or nerve pressure are often witnessed. Thus, for instance, a track traversing the calf, will more or less tie the whole thickness of the structures perforated at one spot, and the apertures of entry and exit may be visibly retracted when the muscles are put in action with consequent pain and stiffness to the patient. ”

“ During the process of healing, position of the parts ought to be carefully attended to; contraction of the cicatrices, and cohesion of opposed surfaces often causing unseemly deformities. Surfaces opposed to each other, and naturally separate, may be prevented from uniting by dressing interposed; and contraction of joints is to be guarded against by keeping the limb extended by splints and bandages. Where deformity has occurred, the hardened cicatrix which is in fault may be either divided or excised, and by paying attention to position in the after-treatment, the evil may be greatly lessened. ”

“ When fully healed, the points of entry and exit are so insignificant as to be less obvious than ordinary acne scars, and later are often hardly visible, but for a considerable period they are often more palpable than apparent. This depends upon the induration of the line of cicatrix corresponding [Pg 78] to the course of the original track which is adherent to the two points. The induration is indeed so marked as to occasionally give rise to the suspicion that a foreign body such as a fragment of lead or of the mantle of the bullet has been enclosed during the healing of the wound. ”

“ Injuries, when they are sufficiently severe to leave permanent scars, destroy the ridges to that extent. If a piece of flesh is sliced off, or if an ulcer has eaten so deeply as to obliterate the perspiratory glands, a white cicatrix, without pores or ridges, is the result (Fig. 7, a) . Lesser injuries are not permanent. My assistant happened to burn his finger rather sharply; the daily prints he took of it, illustrated the progress of healing in an interesting manner; finally the ridges were wholly restored. ”

“ No. 43 shows a scar a little farther back, in the neighbourhood of the ora serrata; but in this case the wound appears to have healed solidly. The pigment of the underlying uveal tissue shows a marked disturbance, whilst before the specimen was cut it was observed that the sclera was pigmented in the neighbourhood of the cicatrix.
In No. 8 the wound lay in the limbus, and the solidifying scar can be traced right through the thickness of the ocular tunic and down to the mass of inflammatory exudate which surrounds the dislocated lens, and fills the angle of the anterior chamber. ”

“ When protected from injury and irritation in the substance of an internal organ such as the liver, it may become encapsulated by fibrous tissue, and persist in this condition for an indefinite period, or it may be absorbed and leave in its place a fibrous cicatrix. ”

“ As before, simple disease of the conjunctiva passes into purulent ophthalmia. The man, after waiting a while, will go to the doctor and show a large cicatrix in each eye, the result of an ulcerated cornea. Physic can do nothing for him; he remains blind for life. ”

“ Sutures.—Twisted silk sutures are to be preferred, as they do not invite sepsis, as softening catgut does, and retain the parts during the entire time required for healing, while the latter is liable to become separated by uneven absorption, allowing the wound to gape at that point and causing more or less of a cicatrix, so intolerant to patients of this class.
Dressings.—Bulky bandages are not required; they heat the parts, and look unsightly. The author employs antiseptic adhesive silk plaster for covering all external wounds, except where the hair prevents its use. ”

“ My house- surgeon, Mr. Hector Cameron, applied carbolic acid to the whole raw surface, and completed the dressing as if for compound fracture. The hand remained free from pain, redness or swelling, and with the exception of a shallow groove, all the wound consolidated without a drop of matter, so that if it had been a clean cut, it would have been regarded as a good example of primary union. The small granulating surface soon healed, and at present a linear cicatrix alone tells of the injury he has sustained, while his thumb has all its movements and his hand a fine grasp. ”

“ Sometimes, however, important structures, including joints, bones, and large blood-vessels, are destroyed; in such cases, even if life be spared, great deformity may ensue from different forms of ankylosis, or from strangulation of a distal part by a contracting cicatrix. ”

“ Never should so large a quantity of the mass be injected as to cause blanching of the narrow strip of skin. This is sure to result in gangrene of some, if not all, of the skin of the subseptum—a result much to be regretted, since subsequent correction of the deformity increased by the contraction of the dermal cicatrix is rendered well-nigh impossible by reason of this very tissue.
Hard paraffin injected in its molten state is never borne in this part of the human economy. ”

“ In the tuberose variety of nævus, where red tumors suggestive of a strawberry, cherry, or flattened tomato are to be removed, a resulting cicatrix is unavoidable, and either acids, electrolysis, or the platinum cautery may be advantageously used. ”

“ In women there may be an old cicatrix in the neck of the womb or a lump in the breast; the circulation has been impaired for several years and now because of the overstimulation that has been going on so long, there is a greatly enfeebled circulation and deposits are taking place. The tumor in the breast becomes cancerous; the scar in the womb takes on malignancy; the arteries harden; the circulation in the spinal cord becomes so impaired that induration is induced followed by ataxia ”