HEALING OF EXTERNAL WOUNDS. 
413 
vessels quickly develop for its sustenance and growth. The 
blood vessels proliferate by a process of budding or sprouting 
from the neighboring uninjured vessels, and develop rapidly 
with the formation of numerous loops, which give a reddish 
color to the tissue. About each loop is a collection of cells 
which give to the tissue a beady appearance. The rich, vas¬ 
cular supply favors a rapid cell growth and an abundant pro¬ 
liferation. From connective tissue cells, fibroblasts are formed, 
which change into branch and spindle-shaped cells, and later 
lie closely together, forming the bundles of fibres which con¬ 
stitute the cicatricial tissue. Granulation tissue is the next 
stage, and is developed from the embryonic by the formation of 
cellular elements similar to the parent tissues. Part of the 
cells are enlarged or hypertrophied tissue cells which undergo 
division and enlargement indefinitely, depending oil the extent 
of the injury and favorable termination of the whole process. 
When it develops into granular masses it is popularly known 
as “proud flesh,” and is a source of uneasiness to the layman. 
While it is confined to the cavity which it attempts to fill or 
does not project beyond the edge of the wound, no interference 
is necessary, as it is the proper and only means of repair. 
This tissue is also very vascular and is very easily injured, be¬ 
cause it has no protective covering. The third stage is the 
development of granulation into cicatrical or scar tissue. This 
is accomplished through the formation of branched and spindle- 
shaped fibroblasts which unite into bundles. Proliferation of 
the epithelium has followed the filling up of the cavity as far 
as possible, and when it ceases the rest of the new tissue is cov¬ 
ered bv a dense laver of cicatricial tissue, or “scar.” At this 
stage the scar is reddish in color, smooth, devoid of hair or 
glands of the skin and tender to the touch. With the forma¬ 
tion of cicatricial tissue the reparative process is completed, 
although changes still occur. Contraction begins, causing 
atrophy of all its tissues. .Blood vessels, nerves and connective 
tissues diminish and consequently the size of the cicatrix, and 
may lead to deformity and partial loss of function. It becomes 
