THE HEALING OF WOUNDS 15 



Define healing by secundam intentionem. 



The filling of a -wound-gap by granulations with, pus 

 formation. 



What wounds usually heal by second intention ? 



All those where the fundamental principles upon which 

 the healing by first intention is based have been disregarded. 

 Therefore, infected wounds, those with wanting close approxi- 

 mation of the edges, contused wounds, etc. 



Describe the macroscopical changes seen in healing 'per 

 secundam. 

 During the first forty-eight hours the various tissues can 

 be recognized ; at this time the surrounding neighborhood 

 begins to swell, is reddened, exhibits increased heat and pain. 

 About the second day the wound surface looks gray, due to a 

 thin layer of coagulated plasma coming from the cut lymph 

 vessels. During the next few days swelling and pain increase 

 some more, the wound surface having a jelly-like, grayish- 

 red look . About the fourth day the discharge from the wound 

 is yellowish and opaque ; at this time the coagulated plasma 

 resting upon the wound surface breaks up and, together with 

 necrotic tissue shreds, is carried away in the wound discharge; 

 now little red points are seen everywhere provided the wound 

 is first cleansed by irrigation. The fifth to sixth day these 

 red points, which are granulations, have grown higher and 

 are covered with thick grayish- yellow pus. Up to the eighth 

 day these granulations become larger, so as to fill the gap 

 between the wound edges pretty well. About the eighth day 

 the wound surface decreases and the edges approximate. 

 "Whenever the granulations are even with the level of the skin 

 the granulating surface becomes smooth and glistening and 

 no further granulations are formed. Next, the periphery of 



