A system of surgery . ilated veins on the sur-face which are not veryvascular and which creakunder the scalpel. Thesurface is smooth andglistening and raised, andfrom the major mass no-dules or claw-like pro-cesses may extend overthe adjacent skin around be-comes pulled on, and inthis way great deformityresults. This condition of cheloid seems to be dependent on someconstitutional state, and is supposed to be more especially associatedwith tuberculous disease. It is often noticed in wounds whichhave been irritated unduly. Certain it is that in some personsevery scar, even the mi
A system of surgery . ilated veins on the sur-face which are not veryvascular and which creakunder the scalpel. Thesurface is smooth andglistening and raised, andfrom the major mass no-dules or claw-like pro-cesses may extend overthe adjacent skin around be-comes pulled on, and inthis way great deformityresults. This condition of cheloid seems to be dependent on someconstitutional state, and is supposed to be more especially associatedwith tuberculous disease. It is often noticed in wounds whichhave been irritated unduly. Certain it is that in some personsevery scar, even the minutest, tends to thicken and become cheloidin this way. These scars do not, as a rule, cause any pain, butthey are heavy and unsightly, and are very apt to ulcerate andbleed. They are often the seat of great itching and there maybe neuralgic pains in them. On examining the structure micro-scopically, there is found to be marked proliferation of the fibroustissue, and in the growing parts there are numerous cells. They. Fig. 42.—Same Case as Fig. 41, after the Arm had beenseparated from the Side and the raw Surfaces madeto heal at once by Skin-grafting. 232 WOUNDS AND CONTUSIONS. do not usually penetrate below the skin, keeping where they affectthe skin itself to the surface of the dermis, leaving the papillarylayer intact. As regards the treatment, the condition is an excessively difficultone to get rid of. At first sight one is often tempted to cut outthese cheloid scars; but as a rule the condition is simply reproducedin the scar so formed, and not only along the line of incision, but alsoin the stitch tracts, and the resulting deformity may be equally badwith the original. Nevertheless, I think that in some cases whereone has to do with a large broad cheloid, and where it is possibleto bring the edges of the skin together, one may very much improvematters, even although one does substitute a linear cheloid scar forthe original mass; and if an attempt be made to dissect out
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