A system of surgery . fig. 37.—Granulations from the Surface of aWound, showing the Buds, the numerousyoung Blood-vessels shooting up into each, andthe Organisation of the deeper Layers intofibrous Tissue. HEALING BY GRANULATION. 205 on till by-and-by the wound is completely healed, and we have ascar which is considerably smaller in area than the original wound. While healing is going on, one can easily distinguish two or threelayers around the central granulations, the outer layer being a whitering, where there are considerable masses of epithelium which havebecome macerated by the discharge
A system of surgery . fig. 37.—Granulations from the Surface of aWound, showing the Buds, the numerousyoung Blood-vessels shooting up into each, andthe Organisation of the deeper Layers intofibrous Tissue. HEALING BY GRANULATION. 205 on till by-and-by the wound is completely healed, and we have ascar which is considerably smaller in area than the original wound. While healing is going on, one can easily distinguish two or threelayers around the central granulations, the outer layer being a whitering, where there are considerable masses of epithelium which havebecome macerated by the discharge ; inside this a bluish layer, wherethere is a moderate thickness of epithelium ; and the innermost layerof all being a pink layer, where there are only one or two strata ofepithelial cells through which the red granulations show (Fig. 38).This pink layer generally indicates that healing has occurred withinquite a recent period, usually within 24 or 48 hours, and it is ofgreat import- .:?- ?i .-i .\.. 38. — Healin?Edge of a Wound,showing the Epi-thelium spread-ing over the sur-face. The thinlayer of epithe-lium of the re-cently healedpart is well seen. ance as indi- i eating whether mthe process is „N>-*actively going ||on or not. •„•, When the -££ scar is first ||| formed it is red llf on account of :^V ;?.**•; the large num- ;$V*£v\» ber of new :i •?*/?£** vessels which ^7/v$£ have been V«>J-V«I. formed in the ;:T-{-!«(ft: granulation tis- .•: •=?.•-^ sue, but as time /l.*>:;. goes on it be- *•*•?&::.. comes paler, ;V-( ?*. \{lr$$J*and ultimately «*>*%..-***««*? is whiter than the surrounding skin, because the new vessels have becomecompressed and disappear as the result of the contraction of thefibrous tissue (Fig. 39). 3. Healing by union of granulations.—About the beginning of the century it was very much the fashion in some quarters not toattempt in any circumstances to obtain union by first intention,on
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