Scar

SCAR, a product of pathological tissue regeneration that arises at the site of an inflammatory process. In other words, a scar is the final stage of all inflammatory diseases accompanied by more or less significant loss of substance when this loss cannot be replaced by physiological tissues. As a rule, scarring is preceded by the development of granulation tissue. Macroscopically, a scar appears as reddish, pale pink, or whitish formations in the form of strips, stars, or sometimes fields of the most irregular shape. Reddish tones are characteristic of young scars, whitish tones of older ones; in the former, there are still significant remnants of vessels of the former granulation tissue [see separate table (vol. XXVIII, art. 247-248), fig. 1]; older scars, on the other hand, are almost avascular formations. The main tissue constituting a scar is dense connective tissue composed of compactly arranged collagen fibers. This compactness in the arrangement of fibers, the thickness of the latter, as well as the atypicality of their arrangement in relation to the substrate, are preserved in a scar for many years. Small delicate scars may, over time, lose these properties, becoming barely noticeable even histologically. Depending on the site of scar development, the function of the organ in which they are located, the structure of the scar may undergo changes, for example, the appearance of a large number of elastic fibers (scar at the site of gastric ulcers, hard chancre), smooth muscle (for example, in organs that periodically change their volume - lungs, renal pelvis, urinary bladder). In the nervous system, scars are often composed of neuroglial elements (so-called glial scars). The functional significance of scarring most often consists in closing and eliminating a given pathological focus or isolating it from surrounding healthy tissues. So-called encapsulation is a particular case of scarring. Since scarring, especially on a large scale, is accompanied by contraction and pulling together of the edges of the area of wound healing, it is natural that scars are often a cause of various organ deformations and disfigurements; on the same ground, strictures (strictures) of canals arise, up to complete obstruction even of such organs as the intestine, stomach, trachea. A particular tendency to contraction is observed in chronic inflammatory processes preceding scarring (syphilis, tuberculosis, gonorrhea, etc.). A variety of scars are so-called synechiae, or organ adhesions, arising in body cavities during the organization of various exudates, around necrotic substrate, parasites, hemorrhages, etc. Scars may, over time, undergo peculiar changes. _;For example, excessive development of bundles of collagen fibers in the form of coarse hyaline beams (see Keloid) may be observed. Sometimes a new pathological process develops at the site of a scar, for example, cancer. Scars are often the object of medical intervention if they contract, bridge, or disfigure organs.

I. Davydovsky. Due to the shrinking and reduction in volume of the entire area of the wound or defect, a scar is always smaller than the damage at the site of which it formed. In terms of its depth, scars that involve tendons, vessels, nerves, or that fuse mobile soft parts with bone are of particular practical importance. The location of a scar, its extent, and shape determine a number of functional disorders. Essentially, scar tissue is always inferior to the tissue that was present at that site, but under favorable conditions these functional disorders are not clinically defined. However, even significant, though superficial, skin scars lead to a loss of elasticity of that area, can cause joint contractures, so-called dermatogenic and desmogenic contractures, can deprive, for example, hairy parts of the head of their hair cover, cause eyelid eversion, mouth curvature, etc. Circular and even semicircular scars, especially on tubular organs, such as: intestines, ureters, urethra, etc., cause so-called strictures, which with well-developed scars can narrow the lumen of the tube so much that the movement of its contents becomes completely impossible, which leads to severe clinical pictures of intestinal obstruction, urinary retention, etc. A scar surrounding a nerve trunk and compressing it, upon contraction, can cause intolerable pain (causalgias), disorders of motor functions, or trophic disturbances. Furthermore, scars fixing mobile organs cause a whole range of the most diverse disorders, the clinical picture of which depends on the location of the scar and the functional disorders caused by the presence of the scar, for example, fixation of the uterus to the back, bends of the intestine, adhesion of the lung to the chest wall, etc. Such pictures often present great difficulties for recognition and even greater difficulties in their elimination. Many different methods have been proposed to soften scars and impart to them the necessary pliability for functional purposes. These include: the application of massage, mechanotherapy, hot air, etc. Among dissolving and softening agents for scars, fibrolysin and choline have been proposed, however with little encouraging results. More satisfactory results are obtained from a 1-2% solution of pepsin (Pregla). Surgical technique must always take into account the possibility of postoperative disorders due to the presence of scars, namely, the location of the incision must take into account the possibility of narrowing of the lumen of a hollow organ by a future scar, for example, intestines; by careful peritonization, one can prevent scar adhesion of mobile organs, etc. The same must be considered in the treatment of injuries and purulent wounds and diseases. The presence of a scar is often an indication for surgical intervention, for example, in contractures, facial skin deformities, bends of the intestines, fixation of organs, strictures of hollow organs, etc. Insufficient or delayed formation of scars deserves special mention, and on the other hand, excessive formation of them. The first occurs from factors slowing down regeneration during the healing of injuries, the second is the result of the action of irritants on the scar area; excessive scars, keloids, are essentially tumors of scar tissue (see Keloid).

s. Girgolav. RUBIA TINCTORUM L., madder, dyer's madder, a perennial plant of the family Rubiaceae, cultivated for the extraction of a dyeing substance. It occurs in the southern regions of the USSR. From the root, dyeing substances alizarin, xanthopurpurin, and pseudopurpurin are obtained. Previously it was used in rickets, but at present it is completely abandoned. In folk medicine, extracts from the root obtained by prolonged boiling or maceration with alcohol (vodka) are used; in this case, two types of extract are obtained - mucilaginous and resinous. The first is used for the treatment of acute articular rheumatism (6.0 in 200.0 - four times a day by a tablespoon), and the second for the chronic form of articular rheumatism (6.0 in 300.0 of weak alcohol). R. t. is also applied in folk medicine for bone tuberculosis.