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Updated: June 28, 2025
So long as there is dead bone there will be suppuration from the granulations lining the cavity in which it lies, and a discharge of pus from the sinuses, so that the mere persistence of discharge after an attack of osteomyelitis, is presumptive evidence of the occurrence of necrosis.
It is very rare that anthracite offers any discernible trace of organization. Preparations made from fragments of Sable and Lamore coal could not be made sufficiently thin to be transparent; the mass remained very opaque, and the clearest parts exhibited merely amorphous, irregular granulations.
In more severe infections the exudate consists of pus mixed with fibrin, and, it may be, red blood corpuscles purulent or suppurative synovitis; the synovial membrane and the ligaments are softened, and the surface of the membrane presents granulations resembling those on an ulcer; foci of suppuration may develop in the peri-articular cellular tissue and result in abscesses.
The packing may be renewed at intervals until the wound is filled by granulations; or, in the course of a few days when it becomes evident that the infection has been overcome, secondary sutures may be introduced and the edges drawn together, provision being made at the ends for further packing or for drainage-tubes.
If it is decided to scrape away the granulations, the oozing must be arrested by pressure with a pad of gauze, a sheet of dental rubber or green protective is placed next the raw surface to prevent the gauze adhering and starting the bleeding afresh when it is removed.
Now, is there any method by which lost finger-tips can be restored? I know of one case where the end of a finger was taken off and only one-sixteenth inch of the nail was left. The doctor incised the edges of the granulating surface and then led the granulations on by what is known in the medical profession as the 'sponge graft. He grew a new finger-tip.
Where the granulations are vascular and bleed easily, it becomes sanious from admixture with red corpuscles; while, if a blood-clot be broken down and the debris mixed with the pus, it contains granules of blood pigment and is said to be "grumous." The odour of pus varies with the different bacteria producing it.
They grow until they reach the level of the surrounding skin, and so fill the gap with a fine velvety mass of granulation tissue. At the edges, the young epithelium may be seen spreading in over the granulations as a fine bluish-white pellicle, which gradually covers the sore, becoming paler in colour as it thickens, and eventually forming the smooth, non-vascular covering of the cicatrix.
Any ulcer may get into a weak state from receiving a blood supply which is defective either in quantity or in quality. The granulations are small and smooth, and of a pale yellow or grey colour, the discharge is small in amount, and consists of thin serum and a few pus cells, and as this dries on the edges it forms scabs which interfere with the growth of epithelium.
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. Healing by Union of two Granulating Surfaces. In gaping wounds union is sometimes obtained by bringing the two surfaces into apposition after each has become covered with healthy granulations.
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