HYPERTROPHIED SCARS.—When a wound is completely healed, a cicatrix or scar occupies its place. Normally, two things are observed in a scar: its con traction and the gradual perfecting of its tissues. The principal changes by which the latter is accomplished are the re moval of all the rudimental textures; the formation of elastic tissue; the im provement of fibrous or fibrocellular tis sue of the new cuticle till they are al most, but not exactly, like those of natu ral formation; and the gradual loosening of the scar, so that it may move easily upon the subjacent tissues. The scar also becomes paler and more shining than the surrounding unaffected skin, for the numerous vessels, which the granulating surface possessed, gradually disappear, and are, for the most part, converted into fibrous cords. In some cases, especially after burns, the evolu tion of the scar does not follow this typical course, but, on account of the prolonged period of cicatrization conse quent upon extensive loss of substance, an hypertrophy of a non-malignant char acter attacks the scar-tissue, sometimes resulting in the formation of masses of dense fibrous tissue varying in size and shape. These hypertrophied sears, on the completion of cieatrization or shortly afterward (from progressive contraction), may occur as nodular or warty excres cences, stellate, or in the form of bridles or reticular bands. This hypertrophic process also occurs, late after cicatriza tion, in apparently normal smooth sears, giving rise to tumors of various shapes; the etiology in these cases is unknown, especially when the hypertrophy follows a linear incision. In these hyper trophied sears the papillary layer of the skin is wholly lacking, and the com ponent bundles of fibrous tissue arc dis arranged. The blood-supply, at first abundant, lessens pan: passe with the contraction of the sear-tissues.
Treatment. — The indications in this condition are best met by excising the hypertrophied scar and covering in the vacant space by a plastic operation. The
resulting scar being greater than the original one, this method of treatment is not one of general application, and, more over, the new cicatrix may also become the seat of hypertrophy.
ELorn.—Keloid (cheloid; kelis; Ali bert's keloid; spurious keloid) is a new growth of connective-tissue formation having its seat or origin in scar-tissue and resulting in the formation of single or multiple tumors.
Symptoms.—It first appears as a pale red nodule which slowly increases in size, assuming a more or less oval form, with irregular, well-defined, radiating projections. From its resemblance to a crab it derives its name. It may more rarely assume a linear form. The new growth is smooth, firm, elastic, pinkish, elevated, generally devoid of hair, usually painless, but sometimes tender when touched or subjected to pressure; and is occasionally the seat of the most intolerable itching, which no external application seems to relieve. The favor ite location of this growth is over the sternum, but it may be situated on the inammie, the neck, arms, and ears. In rare instances the growth may become inflamed and assume for awhile the ap pearance of malignancy, which appear ance disappears usually with the spon taneous decline of the inflammatory ac-, Lion. The development of the growth may be slow or rapid, until a stationary period is reached, which varies in dura tion. Spontaneous disappearance of the growth not infrequently occurs. In some cases the growth becomes painful, in others a pigmentary deposit is noticed. This condition was first described by Alibert, and is known as spurious keloid to distinguish it from true keloid, which does not attack scars (Erichsen).
Diagnosis.—Alibert's keloid is differ entiated from a simple cicatrix by its difference in consistence, outline, color, and elevation, and by its increase in size. Its points of difference from hyper trophied scars have been mentioned.