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Updated: September 28, 2025
To allow the pus to escape, it is necessary, under local anæsthesia, to cut away the nail fold as well as the portion of nail in the infected area, or, it may be, to remove the nail entirely. If only a small opening is made in the nail it is apt to be blocked by granulations.
They are small in size and have prominent granulations, and by the aid of a probe points of excessive tenderness may be discovered. These, Hilton believed, correspond to exposed nerve filaments. Ulcers which are spreading may be met with in one of several conditions. The Inflamed Condition.
As soon as the danger of suffocation is over, the edges of the wound should be freshened and the skin surfaces brought together with sutures. Only the skin without the cartilage should be sutured, and general treatment for encouraging union should be employed. If the wound fails to heal immediately, a treatment calculated to encourage granulations should be undertaken.
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.
Treatment by hyperæmia, using a suction bell, should first be tried, and, failing improvement, the nail-fold and lunule should be frozen, and a considerable portion removed with the knife; if only a small portion of the nail is removed, the opening is blocked by granulations springing from the matrix. A new nail is formed, but it is liable to be misshapen.
They are not infrequently multiple, and this, together with their depth, may lead to their being mistaken for ulcers due to syphilis. The base of the ulcer is covered with imperfectly formed, soft, œdematous granulations, which give off a thin sero-purulent discharge. The edges are slightly inflamed, and show no evidence of healing.
Oftentimes, in severe cuts, and generally in lacerations, there is a loss of tissue, so that the wound heals by "second intention"; that is, the wound heals from the bottom by a deposit of new cells called granulations, which gradually fill it up. The skin begins to grow from the edges to the center, covering the new tissue and leaving a cicatrix or scar with which every one is familiar.
Nevertheless, when it came on to snow, as Gabriel had predicted, the skating party was by no means so near home as he had imagined. A shrewd keenness and some stimulating electric condition of the atmosphere had tempted the young people far out on the lake, and they had ignored the first fall of fine grayish granulations that swept along the icy surface like little puffs of dust or smoke.
While these changes are taking place in the deeper parts of the wound, the surface is being covered over by epidermis growing in from the margins. Within twelve hours the cells of the rete Malpighii close to the cut edge begin to sprout on to the surface of the wound, and by their proliferation gradually cover the granulations with a thin pink pellicle.
When foci of suppuration have been scattered up and down the medullary cavity, and the bone has died in patches, several sequestra may be included by the new case; each portion of dead bone is slowly separated, and comes to lie in a cavity lined by granulations.
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