370 WILLIAM H. COLE 



of the fitting of the transplant to the wound. If the latter is 

 exactly covered, the healing process, as already stated, is very 

 short, complete union being established by the end of twelve 

 hours. If, on the other hand, the transplant is too small or too 

 large for the wound, the healing process is greatly prolonged and 

 firm union may not be estabhshed until the end of thirty-six or 

 forty-eight hours. A graft which is too small has a stretched 

 appearance during this period, as though the epidermal cells, 

 moving out over the wound, exerted a centrifugal pull on the 

 whole mass. This favors firm and complete union of the trans- 

 plant with the host integument along all its edges, pro\dded the 

 distances between the four sides of the graft and the host integu- 

 ment are nearly equal. If one side is much farther away from 

 the host integument than the opposite one, the former will be 

 prevented from uniting because of being pulled away from the 

 incision (fig. 1). Such a free edge will hasten the absorption 

 process, which will be described in the next paragraph. A trans- 

 plant of excessive size exhibits a turning under of its projecting 

 edges. If all sides project, an increase in the convexity of the 

 whole graft is produced during the healing period; if only one, 

 the increase is limited to that side. If the overlap is not too great 

 (less than about 2 mm.) , the curved-in edges and the edges of the 

 host integument unite. But since such grafts commonly are 

 puckered at one place or another, union is rarely complete. In 

 any event, a transplant too large for the wound is more convex 

 than one of the right size or one somewhat too small and is less 

 likely to be completely united. The first period, then, varies, 

 its length being from twelve to forty-eight hours, at the end of 

 which time the graft is attached to its host along the whole, or 

 nearly all, of its periphery. During this time there is no external 

 sign of vascular congestion, although sections show accumula- 

 tions of blood cells in the dermis. 



(2) Second or adjustment period. Since all living tissues are 

 continually being worn away or used up, the effete elements be- 

 ing replaced through regeneration, it is to be expected that trans- 

 planted tissue will undergo similar changes. If the replacement 

 of tissue does not keep pace with wastage, then the transplant 



