Ferrugination caused by Monsel's solution. Clinical observations and experimentations.
Ferrugination of fibrin, dermal collagen, and striated muscle fibers may result from the application of Monsel's solution (20% ferric subsulfate) for hemostasis to wounds caused by excisions of skin. The collagen fibers in the dermis are coated with a slightly refractile, gray-brown substance which is strongly positive with Perl's reaction for iron. Ferruginated collagen fibers are eliminated through the epidermis as the epidermis regenerates. Some of the ferruginated fibers become calcified. Siderophages are present in these and adjacent areas. Seepage of Monsel's solution into deeper tissues at the site of biopsy may result in ferrugination of skeletal muscle, perichondrium, and even cartilage. We applied Monsel's solution to biopsy sites caused experimentally in a rabbit and confirmed the capacity of the solution to produce ferrugination of collagen fibers and skeletal muscle. Ferrugination of collagen fibers becomes less pronounced as the wounds heal and as iron pigment is taken up by macrophages. Ferruginated fibers of skeletal muscle act as foreign bodies to elicit a granulomatous reaction. Comparison of biopsy sites to which Monsel's solution had been applied with biopsy sites to which the solution had not been applied indicates that the substance does not seem to interfere with the rate of epidermal regeneration. However, when there is injury to skeletal muscle and other deep tissues by Monsel's solution, an inflammatory reaction persists at these sites for weeks.