Vascular growths not unfrequently form in the scalp, and attain
considerable size; in general they are either congenital, or the
degenerations of nævi materni. They may be so extensive as to forbid
surgical interference; or they may be so indolent, may partake so much
of the nature of simple varix, as not to warrant it. If small, they
can be readily removed by the knife, the incisions being made rapidly,
and wide of the diseased structure. If the tumour be prominent,
extensive, and at all active, the employment of ligature is a more
safe and equally effectual practice. One or two ligatures may suffice
to encircle the swelling, or, as in other parts of the body, it
maybe necessary to pass a great many double ones beneath the part,
to separate their extremities, and to tie them to each other around
the base of the tumour, the last being drawn so as to tighten all the
others. Little benefit can be expected from tying, either at once or
at different periods, the larger arterial trunks whose ramifications
supply the diseased structure, the inosculation amongst the vessels
around the tumour being so extremely free. But, in cases where the
disease cannot be otherwise combated with any hope of success, ligature
of the common carotid, on the affected side, may be tried as a last
resource. The practice has proved successful in some cases of this
disease, involving parts of the head and face to such an extent, or in
such a situation, as to forbid any attempt at removal of the growth.
Encysted tumours frequently form in the scalp, and, if undisturbed,
become large; they seldom occur singly. The disease appears in many
cases to be hereditary, and it frequently happens that several members
of one family are at the same time afflicted with it. The contents of
the tumours vary as to consistence, but are generally atheromatous.
The cyst is thick, and loosely connected with the surrounding cellular
tissue; but as the tumour increases, the adhesions often become firm
and intimate, more especially towards the skin. When the tumour is
of small size, it is unnecessary to adopt any preparatory measures
for its removal, not even to shave the scalp: the surface may be
cleared a little with scissors. The swelling is transfixed, in the
direction of the fibres of the occipito frontalis, by means of a curved
sharp-pointed bistoury, and its internal structure is exposed by the
knife being carried outwards. The soft contents are evacuated, and
the sac is easily extracted by means of common dissecting forceps.
The integuments are then laid down and retained in apposition, no
sutures being necessary, and in many cases the wound heals by adhesion;
sometimes a small coagulum forms between the edges of the wound, and
is detached some days afterwards; then slight suppuration ensues.
In larger tumours, however, a straight and narrow knife is perhaps
the most convenient instrument for accomplishing removal. The part
is transfixed, and in most cases it is necessary to take away an
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