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Thiersch contends that healing of a granulated surface results first from a conversion of the soft, vascular granulation-papillae, by contraction of some of their elements into young connective-tissue cells, into "dry, cicatricial papillae," actually approximating the surrounding tissues, thus diminishing the area to be covered by epidermis; and, secondly, by the covering of these papillae by epidermic cells.
Should the raw surface left be likely to result in an unsightly scar or in cicatricial contraction, skin-grafting should be employed. For extensive ulcers on the limbs, the chest wall, or on other covered parts, or when operative treatment is contra-indicated, the use of tuberculin and exposure to the Röntgen rays have proved beneficial.
If the ends of a divided striped muscle are at once brought into apposition by stitches, primary union takes place with a minimum of intervening fibrous tissue. The nuclei of the muscle fibres in close proximity to this young cicatricial tissue proliferate, and a few new muscle fibres may be developed, but any gross loss of muscular tissue is replaced by a fibrous cicatrix.
Inside of mouth corroded. There are also dysphagia, thirst, dyspnoea, small and frequent pulse, anxious expression, shock. Death may result from shock, destruction of the parts e.g., perforation of stomach or duodenum, suffocation; or some weeks subsequently death may be due to cicatricial contraction of the gullet, stomach, or pylorus. Post-Mortem Appearances.
The spaces between these loops are filled by cells of various kinds, the most important being the fibroblasts, which are destined to form cicatricial fibrous tissue.
The application of the X-rays has proved beneficial in synovial lesions in superficial joints such as the wrist or elbow; prolonged exposures are made at fortnightly intervals, and on account of the cicatricial contraction which attends upon recovery, the joint must be kept in good position.
It may be noticed in animals that have ring-bone, or coffin-joint lameness. The most common cause for this unsoundness is inflammation of the muscles and tendons of the flexors of the digit. As a result of long standing or severe inflammation, shortening of these structures occurs in consequence of the contraction of the inflammatory or cicatricial tissue.
In small arteries these clots extend as far as the nearest collateral branch, but in the larger trunks their length varies. The permanent occlusion of those portions of the vessel occupied by clot is brought about by the formation of granulation tissue, and its replacement by cicatricial tissue, so that the occluded segment of the vessel is represented by a fibrous cord.
It would appear that the most marked changes take place in the submucous tissue, causing the covering epithelium in places to die and leave small superficial ulcers, for example in gonorrhœal urethritis, the cicatricial contraction of the scar subsequently leading to the formation of stricture. When mucous glands are present in the membrane, the pus is mixed with mucus muco-pus.
All moist or greasy applications, such as Carron oil, carbolic oil and ointments, and all substances like collodion and dry powders, which retain discharges, entirely fail to meet the indications for the rational treatment of burns, and should be abandoned. Skin-grafting is of great value in hastening healing after extensive burns, and in preventing cicatricial contraction.
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