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SCARS 

Scars are areas of fibrous tissue that replacenormal skin after injury. A scar results from thebiologic process of wound repair in the skin

and other tissues of the body. Thus, scarring isa natural part of the healing process.

With the exception of very minor lesions, every

wound (e.g. after accident, disease, orsurgery) results in some degree of scarring.

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scars in the skin are less resistant to ultravioletradiation,

and sweat glands and hair follicles do not grow

back within scar tissue

A myocardial infarction, commonly known as aheart attack, causes scar formation in the

heart muscle, which leads to loss of muscularpower and possibly heart failure.

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Etymology

First attested in English in late 14th century,the word scar derives from Old French escharre , from Late Latin eschara ,[2] which is

the latinisation of the Greek ἐσχάρα (eskhara ),meaning "hearth, fire-place", but in medicine"scab, eschar on a wound caused by burningor otherwise"

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How scarring occurs 

If a wound re-epithelizes within two weeksthere will be minimal collagen deposited andthere will be no scar .

And generally if a wound takes longer thanthree to four weeks to re-epithelize a scarforms.The scar is a result of the body's patchup reaction after injury on many tissues.

Any injury does not become a scar until thewound has completely healed; this can takemany months, or years in the worstpathological cases like keloids

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To begin to patch the defect a clot is created; theclot is the beginning process that results in aprovisional matrix.

In the process the first layer is a provisionalmatrix and is not scar.

Over time the wounded body tissue then over-expresses collagen inside the provisional matrix tocreate a collagen matrix.

This collagen over expression continues andcross-links the fiber arrangement inside thecollagen matrix, making the collagen dense.

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The scarring is created by fibroblast proliferation,a process that begins with a reaction to the clot.

To mend the damage, fibroblasts slowly form the

collagen scar.

The fibroblast proliferation is circular andcyclically, the fibroblast proliferation lays down

thick whitish collagen  inside the provisional andcollagen matrix, resulting in the packed abundantproduction of collagen on the fibers giving scarstheir uneven texture.

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Over time, the fibroblasts continue to crawlaround the matrix, adjusting more fibers and,

in the process, the scarring settles andbecomes stiff.This fibroblast proliferation alsocontracts the tissue.

skin Scars: Skin scars occur when the dermis (the deep, thick layer of skin) is damaged.Most skin scars are flat and leave a trace ofthe original injury that caused them

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During healing process.

Hair follicles are lost.

Sweat glands are lost.

But vascularity remains

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Characteristics of scar

Taken the shape of wound causing it.

It may be linear- if formed by primary union

Wide & thicker at centre then periphery-

formed by formation of granulation tissue. Scar at the loose skin (axilla & genital) may

irregular & such scars may be smaller then theoriginal wound.

Broad Irregular Scar- formed by laceratedwound. Generally formed by healing processof secondary intention.

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Due to various injuries – generally formedafter, burn, laceration injuries. These can be

-large irregular- burn & scaled. (after

companied by Keloid)

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Burn scar often variable depending up on

- area involved in burn

- part of the body involved

- nature of healingprocess

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Scar from Bullet injuries- large than bullet,irregular and surround by grains of gun powder ofshot with in few inches range

If the distance is increased- shape is depressed,

adherent in the center & small than bullet. Wound of entry is smaller then exist – similarly the

scars also.

If there is any doubt in gun shot wounds scars X-

ray can be done to prone it. Scar from stab wound – triangular smaller in size

than the blade of the weapon.

Scar resulting from leech bite – triradiate

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Appearance of Scar 

Scar generally appear in 4-5 days whenwound heals under scab like superficial cuts.

In clean cut- healing takes place by Ist intention

Scar appear in fort night (15 days)

In lacerated wound – it appear 2 wk to threemonth

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Disappearance of scar 

Superficial linear scar (involving only epidermis)(or cuticle) – may disappear in due course of time

Scars which involve whole thickness if skin – always permanent

It not possible to remove the scar successfully But its size can be altered by some operative

procedure

A faint scar can be made visible by applying rub or

applying heat (surrounding skin will be come red&whitish scar will appear)

When ever necessary a magnifying glass can beapplied for identification of scar.

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Age of scar 

It is very difficulty to tell the exact age of ascar. So caution answer should be given incourt.

Scar when first formed red and tender underthe scab. Then turn to brown and lastly white &glistening appearance.

These changer are generally produced over aperiod of three to four months – but variation isso great that no fix time can be fold.

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Tattoo

A tattoo is a marking made by insertingindelible ink into the dermis layer of the skin tochange the pigment for decorative or other

reasons. Tattoos on humans are a type of decorative

body modification, while tattoos on animals aremost commonly used for identification orbranding.

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Tattooing has been practiced for centuriesworldwide

The Ainu, the indigenous people of Japan,

traditionally wore facial tattoos Today one can find Berbers of Tamazgha 

(North Africa), Māori of New Zealand, Arabic

people in East-Turkey and Atayal of Taiwanwith facial tattoos

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Tattooing was widespread among Polynesian peoples and among certain tribal groups in theTaiwan, Philippines, Borneo, Mentawai

Islands, Africa, North America, South America,Mesoamerica, Europe, Japan, Cambodia, NewZealand and Micronesia.

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the etymology

The etymology of tattoo as "In 18th c. tattaow,tattow. From Polynesian tatau.

In Tahitian, tatu." The word tatau was

introduced as a loan word into English, thepronunciation being changed to conform toEnglish phonology as "tattoo".

Sailors on later voyages both introduced theword and reintroduced the concept of tattooingto Europe.

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Tattoo enthusiasts may refer to tattoos as"Ink", "Tats", "Art", "Shign-Dings", "Pieces", or"Work"; and to the tattooists as "Artists".

The Japanese word irezumi means "insertionof ink" and can mean tattoos using tebori , the

traditional Japanese hand method

urposes ecora ve an sp r ua

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urposes- ecora ve an sp r uauses

Tattooing is a tradition among many of the indigenouspeoples around the world.

Tattoos have served as rites of passage,

marks of status and rank,

symbols of religious and spiritual devotion,

decorations for bravery,

sexual lures and marks of fertility,

pledges of love,

punishment,

amulets and talismans, protection, and

as the marks of outcasts, slaves and convicts

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The symbolism and impact of tattoos varies indifferent places and cultures. Tattoos may showhow a person feels about a relative (commonly

mother/father or daughter/son) or about anunrelated person

Today, people choose to be tattooed for cosmetic,sentimental/ memorial, religious, and magical 

reasons, and to symbolize their belonging to oridentification with particular groups, includingcriminal gangs,but also a particular ethnic groupor law-abiding subculture..

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Identification

People have also been forcibly tattooed. A well-knownexample is the identification system for inmates inNazi concentration camps during the Holocaust 

Tattoos are sometimes used by forensic pathologists 

to help them identify burned, putrefied, or mutilatedbodies. Tattoo pigment is buried deep enough in theskin that even severe burns are not likely to destroy atattoo

For many centuries seafarers have undergonetattooing for the purpose of enabling identificationafter drowning

Mark of a deserter from the British Army. Tattoo onskin and equipment. Displayed at Army Medical

Services Museum 

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Tattoos are also placed on animals, though very rarely fordecorative reasons.

Pets, show animals, thoroughbred horses and livestock aresometimes tattooed with identification and other marks.

Pet dogs and cats are often tattooed with a serial number

(usually in the ear, or on the inner thigh) via which theirowners can be identified.

Also, animals are occasionally tattooed to prevent sunburn(on the nose, for example). Such tattoos are often performedby a veterinarian and in most cases the animals areanesthetized during the process.

 Branding is used for similar reasons and is often performedwithout anesthesia, but is different from tattooing as no ink ordye is inserted during the process.

C

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Cosmetic

When used as a form of cosmetics, tattooingincludes permanent makeup and hiding orneutralizing skin discolorations.

Permanent makeup is the use of tattoos toenhance eyebrows, lips (liner and/or lipstick),eyes (liner), and even moles, usually withnatural colors, as the designs are intended toresemble makeup

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M di l

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Medical tattoo 

Medical tattoos are used to ensure instrumentsare properly located for repeated application ofradiotherapy and for the areola in some forms

of breast reconstruction. Tattooing has also been used to convey

medical information about the wearer (e.g.blood group). Tattoos are used in skin tones tocover vitiligo, skin pigmentation disorder

P l

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Prevalence

Tattoos have experienced a resurgence in popularity in manyparts of the world, particularly in North and South America,Japan, and Europe.

The growth in tattoo culture has seen an influx of new artistsinto the industry, many of whom have technical and fine arts

training. Coupled with advancements in tattoo pigments andthe ongoing refinement of the equipment used for tattooing,this has led to an improvement in the quality of tattoos beingproduced.[6] 

Modern materials and techniques allow for a range ofpreviously impossible designs and colors within tattoo art

In many traditional cultures tattooing has also enjoyed aresurgence, partially in deference to cultural heritage.

Historically, a decline in traditional tribal tattooing in Europe occurred with the spread of Christianity. 

N ti i ti

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Negative associations

Conspicuous tattoos and other body modification can makegainful employment difficult in many fields.

In Japan, tattoos are strongly associated with organizedcrime organizations known as the yakuza , particularly fullbody tattoos done the traditional Japanese way (Tebori ).

In the United States many prisoners and criminal gangs usedistinctive tattoos to indicate facts about their criminalbehavior, prison sentences, and organizational affiliation.[14] 

A tear tattoo, for example, can be symbolic of murder, witheach tear representing the death of a friend.

At the same time, members of the U.S. military have anequally well established and longstanding history of tattooing to indicate military units, battles, kills, etc., an associationwhich remains widespread among older Americans. Tattooingis also common in the British Armed Forces.

P d

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Procedure

Modern tattoo machine in use: here outfittedwith a 5-needle setup, but number of needlesdepends on size and shading desired.

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Tattooing involves the placement of pigmentinto the skin's dermis, the layer of dermaltissue underlying the epidermis.

After initial injection, pigment is dispersedthroughout a homogenized damaged layerdown through the epidermis and upper dermis,in both of which the presence of foreignmaterial activates the immune system'sphagocytes to engulf the pigment particles.

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As healing proceeds, the damaged epidermisflakes away (eliminating surface pigment) whiledeeper in the skin granulation tissue forms, whichis later converted to connective tissue by collagen 

growth. This mends the upper dermis, wherepigment remains trapped within fibroblasts,ultimately concentrating in a layer just below thedermis/epidermis boundary.

Its presence there is stable, but in the long term(decades) the pigment tends to migrate deeperinto the dermis, accounting for the degraded detailof old tattoos.

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The most common method of tattooing inmodern times is the electric tattoo machine,which inserts ink into the skin via a group of

needles that are soldered onto a bar, which isattached to an oscillating unit. The unit rapidlyand repeatedly drives the needles in and outof the skin, usually 80 to 150 times a second

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Traditional two coil tattoo machine

D d i t

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Dyes and pigments

A wide range of dyes and pigments can beused in tattoos, from inorganic materials liketitanium dioxide and iron oxides 

to carbon black, azo dyes, and acridine,quinoline, phthalocyanine and naphthol derivates, dyes made from ash, and othermixtures. Iron oxide pigments are used ingreater extent in cosmetic tattooing 

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Carbon – Indian or Chinese ink. (blue/ blackcolor)

Cinnabar – for red.

Ochre – brown

Chromic oxide – green color

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Professional tattooists rely primarily on thesame pigment base found in cosmetics.Amateurs will often use drawing inks such as

low grade India ink, but these inks oftencontain impurities and toxins which can lead toillness or infection

Health risks

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Health risks

Because it requires breaking the skin barrier,tattooing may carry health risks, includinginfection and allergic reactions. Modern

tattooists reduce such risks by followinguniversal precautions, working with single-useitems, and sterilizing their equipment aftereach use. In amateur tattoos, such as those

applied in prisons, however, there is anelevated risk of infection.

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Infections that can theoretically be transmittedby the use of unsterilized tattoo equipment orcontaminated ink include surface infections of

the skin, herpes simplex virus, tetanus, staph,fungal infections, some forms of hepatitis,tuberculosis, and HIV.[38] In the United Statesthere have been no reported cases of HIV

contracted via commercially-applied tattooingprocess.[39] 

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Tattoo inks have been described as"remarkably nonreactive histologically.However, cases of allergic reactions to tattoo

inks, particularly certain colors, have beenmedically documented

Occasionally, when a blood vessel ispunctured during the tattooing procedure abruise / hematoma may appear. This issometimes due to nickel in an ink pigment,which is a common metal allergy.

Tattoo removal

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Tattoo removal 

Disappear without leaving any wark trace after aperiod at least 10yes → in pigment like →vermition or ultra marive or if the prigment has notpevestrieed to decp skin.

Pigment can be found in theneighouringlyuphnoder (if examined after death)

Mark are indelible if pigment such as (Indian ink,soot, gan powder or powdered charcoal, if havepevetrated deep into the fibne – elastuic tissue.

It can be recognize in dead and decomposedtissue.

Faded one can be revealid – subbing ultravioletlamp.

Infraredphotograph

Artificial removal of tattoo mark

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Artificial removal of tattoo mark 

Surgical

Electrolysis

Caustic substances

Surgical Initially →red hot iron – burn _ healing clears the

dead skin along with it tattoo.

But leaves bad scar.Use of solid carbon dioxide leads to similar mark

Complete excision with graft or sliding flap.

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Over tattooing with titanium oxide →leads towhite pigment

Dem abrasion is not so satisfactory.

Lacangne and J. Raesel →scarification of thetattooed part and then applying finely powdered.Potassium permagnate → after few days scabfall off smooth, colorless, almost unscarred skin

appears

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Electrolysis Miller – needle attached to negative pole if the

battery in order to get the softening action of thealkali produced there.

After the pigment is laid by the needle, it isscraped & picked away from the tissue in whichthe pigment is deported.

Insertion of needle with sufficient no. of time,using a current of 5 to 2 milli amperes.

This forms a superficial Escher, which drop off incourse of week or so leaving white superficial scar

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Application of caustic substance 

Applied to the scar remove the pigment byproducing on inflammatory reaction and a

superficial eschar-- mixture of papain inglycerin.

Brailt:- selection of zine chloride to 40 parts bywater (by needle)

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Variot method:- 

Tattooing into the design a 50% solution of tannicin water and then rubbing it vigorously with a stick

of silvertannate in the superficial of layer of skin. The field of operation in then washed with cold

water.

After 15- day a black slough comes of

spontaneously leaving thin layer of whiteepithelium→ gradually assuming the appearanceof normal skin

This method in applied to accidental tattol in

Occupational mark

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Occupational mark 

Horny callus on shoulder → kahars.

Callous on hypothenar → Indian weigh men 

Callosity on the right middle finger → clerks 

Depression on the lower part of sternum →shoe maker

Needle puncture ((L) index finger) → tailor  

Dyes – photographer, dyes, engineer, chemist