682 WOUND HEALING 8 



1952; Barnes et al., 1953; Hammer et al., 1955; Sanders and Schein, 1956). Split- 

 thickness skin grafts react in the same manner when apphed to a denuded bladder 

 surface in dogs (Draper et al., 1952; Draper and Stark, 1956). Similarly, when 

 skin grafts are used to replace segments of the ureter (Horton and Politano, 1955) 

 there is an overriding at the junction. More recently Herbsman et al. (1957) 

 observed the same phenomenon when grafts of jejunum, ileum, and colon were 

 placed in the oral cavity or bladder. 







Fig. 7. Photomicrograph of a burn scar 18 months following epithelialization (Hematoxylin 

 and Eosin, > 75). Ep — epithelium; Der — dermis. 



Remodeling of the wound. All wounds involving the dermis inevitably leave a scar. 

 A clean wound not situated in areas of excessive tension heals with a minimum of 

 disfigurement. The gross and histological features associated with this remodeling 

 process are relatively constant. Immediately following epithelialization the wound- 

 area is elevated and erythematous for variable periods before it ultimately sub- 

 sides, leaving the scar flattened and blanched. In wounds that have been healed 

 for a long period, the epithelium is characterized by an absence of rete pegs and 

 decreased pigmentation. The dermal layer becomes more cellular and there is no 

 stratum papillaris, nor epithelial elements such as hair follicles and sweat glands. 

 The time interval required for remodeling is affected by such factors as foreign 

 bodies, radiation, and infection. In the presence of these disturbances healing 

 is prolonged but ultimately achieved. The nature of the remodeling process is 

 influenced by the site of the wound formation as well as by constitutional disturb- 

 ances, e.g. keloid formation. The mechanics of scar hypertrophy have been 

 discussed by Ju (1951), as for example in flexor surface incisions perpendicular to 

 the axis of joints or elsewhere parallel to lines of push-pull tension. Such hyper- 

 trophy can be largely obviated by incisions parallel to the joint axis or perpen- 



