Bleeding will be inconsiderable when excision is done rapidly and with the proper digital compression, especially if we avoid cutting into the angioulatous tissue itself. Larger vessels are ligated and sutures are placed in such it manner that they will include the bottom of the wound; thus we will best prevent the formation of hamtatoinata and possible hemorrhage.
Puncture with the Paquelin cautery or the electrolytic needle is used only in parts of the body Where the shorter and more radical total excision is impossible (edge of lid, lobe of ear). Puncture and electroly sis both permit a more conservative procedure and a saving of more of the supporting tissue (carti lage); but this treatment is slow,the scars are extensive and their size cannot he predicted.
Sauerbruch reports success from the treatment of angio mata with liquid carbon diox ide. Carbonic acid snow, which develops when we allow liquid carbon dioxide to escape from the tank, is placed upon the surface of the angioma and left there for from ten to twenty seconds. This is repeated a few times with intervals of from eight to ten days, and the angioma disappears "without leaving any sear" and without causing any pain.
[This treatment originated with the late Dr. A. Campbell White, of New York, who in 1S99 published an article in the Medical Record, "Liquid air: Its application in medicine and surgery." At the meeting of the Sixth International Congress for Dermatology in New York, 1907, Dr. W. A. Pusey, of Chicago, told of his success with carbonic acid snow. —THE TRANSLATOR.] In angiomata covering a large surface (for instance, on the skull) it is preferable to operate in several sessions. We first excise an elliptical piece front the middle of the angioma, catch the edges quickly under compression and unite them. By repeating this two or three times we succeed in removing angiomata, the removal of which at one time would have left defects which it would have been hard to close.
Inoperable angiomata of the face and those which spread over a large surface and go very deep, and which therefore can not be operated upon, may be made to disappear by sticking arrows made of magnesium into the tumor, according to Payr. The arrows are inserted in all direr
tions through a small incision in the skin; absorption of tne metal causes coagulation, dissolution, and scar formation, and thus disappearance of the angiomatous tissue.
In some eases the application of the Röntgen rays, and in others the emanations of radium, have given splendid results in operable angio mata. In one case of angiomatous degeneration of the whole of one upper lip the application of radium for some months produced a per manent cure without any extensive scar.
The injection of alcohol and other irritating liquids was formerly highly recommended to abolish these tumors, but it may cause necrosis and disagreeable symptoms thrombosis, suppuration) and it is therefore better to regard this as an obsolete method of the preantiseptic era.
2. Lymphangioma The structure of lymphangiorna is similar to that of luemang,ioma, and consists of the dilated lymph-vessels. It is usually classified as lymphangioma cavernosum and lymphangioma cysticum, according to whether the cavities intercommunicate and are in open connection with the lymph-channels and may be emptied into them by pressure, or form closed cysts arranged in the shape of grapes.
The favorite sites of the cavernous lymphangiomata are the tongue, check, ear, back of knee, axilla.
The prevalent type of the cystic lymphangioma has already been described limier the congenital diseases as hygroma colli cysticum (p. 39).
The cystic lymphangionnt may also at times be found in other localities (upper arm, axilla, back of knee).
We observed a large multilocular cystic lymphangioma in a child of one year on the root of the mesentery, which filled t he entire abdominal cavity, and owing to the twisted pellicle of one cyst it simulated peri tonitis. The whole tumor looked like a grape and was attached to the mesentery by a thin pedicle. After operation the child remained free from recurrence (Fig. 1SS).
The lymphangiomat a are also regarded as caused by a faulty pre disposition, and this is made more probable by their frequent congenital appearance. They are more malignant than the angiomata, and there fore their radical removal is obligatory (see Hygroma colli cysticum).