In milder cases, where no single large dilated vein seems to call for extirpation, it may suffice to practise Schede’s operation alone. Experience has taught this fact, that in dealing with extensive varices the surgeon is more likely to err on the side of leniency than on that of thoroughness.
VENOUS ANGIOMAS.
These have already been mentioned in the chapter on Tumors as constituting one variety of the angiomas. Many of them are of congenital origin. In many instances they produce erectile tumors. They frequently occur in the liver, in the thyroid, and other internal organs, as well as on the body surface.
A venous tumor, composed of good-sized veins, distended perhaps far beyond their normal capacity, constitutes a compound varix, of which the best expression is a hemorrhoid or a varicocele. Another form is composed almost entirely of capillary veins, which are increased not only in size but also in number. These constitute the growths called “mothers’ marks,” “strawberry growths,” etc. Technically they are venous nevi, which vary in size from trifling lesions to large tumors of varying shapes. These growths are always most conspicuous about the hands and face, because these are the visible parts of the body. They may, however, occur at any point, but mainly about the face and the orbit. A diffuse form, whose area may be almost unlimited, but usually circumscribed, is that called “port-wine mark,” which occurs more frequently about the face. It has been attributed to mental impressions during pregnancy, but there seems little to justify this view. The affected surface is sometimes pigmented and generally more hairy. Surface markings of this kind may accompany that form of neuroma described as plexiform neuroma. [Fig. 183], from Holloway, illustrates another form of congenital growth of this kind. These growths rarely occur in the nasopharynx, where they not only obstruct but are sources of actual danger from hemorrhage.
Fig. 183
Congenital venous nevus. (Holloway).
Treatment.
—The most satisfactory treatment of a limited growth of this kind is excision, especially if this can be made at an early age. The resulting scar will be smaller, the healing more prompt, and the result in every way better. When excision seems impracticable electrolysis should be employed, one or both poles of a galvanic battery of six to ten cells being connected with needles, which are inserted directly into the growth, and whose position is constantly changed, so that the coagulating effect of the electric current may be equably distributed throughout the growth. Occasionally the growth may be so shaped as to permit of ligature, and it is best employed either with or without the use of a needle, after which it may be excised or will slough off. This is essentially one method of treating external hemorrhoids. Methods by injection of coagulants are all open to serious objection, are hazardous, and should be abandoned. A port-wine mark may be sometimes treated by a tattooing process, which should, however, be practised with strict antiseptic precautions. Electrolysis may also be practised over a small area at a time. The more destructive method, by use of the cautery, is likely to leave scars almost as conspicuous as the original condition. Occasionally a lesion of this kind will be so shaped and placed as to justify excision with an autoplastic operation.