Volume 1
Manual of surgery / by Alexis Thomson and Alexander Miles.
- Thomson, Alexis.
- Date:
- 1904
Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Credit: Manual of surgery / by Alexis Thomson and Alexander Miles. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
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![granulatiou tissue is gradually replaced by young cicatricial tissue, and the surface is covered by the ingrowth of epithelium from the edges of the skin. This modification of the reparative [)rocess can be well studied clinically in a wound which, at the time of the operation, has been packed with gauze. When the plug is introduced the walls of the cavity consist of raw tissue with numerous oozing blood-vessels. On removing the stuffing on the fifth or sixth day, it is found that the .surface is covered with minute, red, papillary projections {firanidations), and that already the cavity has become smaller, having been filled in from below by these velvet-like growths. At the edges, too, the epithelium has proliferated and is covering over the newly formed tissue. On subsequently examining the wound at intervals of a few days, it is found that the granulation tissue gradually increases in amount till the gap is completely filled up, and that coincidently the epithelium spreads in and covers over its .surface. In course of time the ei)ithelium thickens, and as the granulation tissue is slowly replaced by young cicatricial tis.sue, which has a peculiar tendency to contract, and so to obliterate the blood-vessels in it, the scar which is left becomes smooth, pale, and depressed. This method of healing is sometimes spoken of as healing by granulation —although, as we have seen, it is by granulation that all repair takes place. llealimj hi/ Union of two Granulating Surfaces.—In widely- gaping wounds closure is sometimes obtained by bringing the two surfaces into a2:)position after each has become covered with liealtliy granulations. The serum effused on the surfaces causes them to adhere, capillary loops pass from one to the other, anfl their final fusion takes place by the further development of granulation and cicati'icial tissue. Repair in Indtvidual Tissues. Having studied the ])rocess of rejiair in general, it will obviate unneces.sary repetition later if the modifications of that process as seen in the I'egeneration of certain of the individual tissues be nfiw considered. Nature's efforts are always directed towards effecting a complete and perfect I'e.stitution to the normal, but her .success varies with the tissue involved and the amount of damage which it has sustained. Any given tissue can only be re]>laced from tissue of a similar kind ; but wliile simple structures such as skin, cartilage, bone, periosteum or tendon, have a high power of regeneration, those of a more complex organisation, such as secreting glands, muscle, and the](https://iiif.wellcomecollection.org/image/b21511093_0001_0029.jp2/full/800%2C/0/default.jpg)
