The naked-eye evidence of all this is to be found in the moisture or
exudation on the surface of a wound. As this forms on both surfaces of
a wound, the exudation is the first bond of union. The fluid portion
of this exudation becomes absorbed, and what remains of it forms the
scaffolding on which the scar is built up. The scar consists of new
connective tissue cells which have grown into this framework, and
multiplied rapidly, causing firm cohesion of the two separate surfaces.
In order that these new cells should be properly nourished they require
a sufficient blood supply, and it is found that while their formation is
proceeding minute new blood vessels shoot forth from the existing ones,
and they grow into the soft newly developing scar tissue. Owing to this
fact, free oozing of blood takes place when a healing wound is disturbed.
In the operation of circumcision it is well seen how the circulation of
the blood re-acts to injury. When the mucous membrane covering the glans
is exposed it looks pale and translucent, because of its scanty blood
supply and its thinness. Very soon after it has been torn through, its
whole character changes. It becomes engorged with blood, it becomes red
and congested it loses its translucency, and at its lacerated edge the
process of healing takes place as detailed above.
All scars are at first pink in colour, because more new blood vessels are
formed than are required for the permanent nourishment of the part when
completely healed. In the course of time these blood vessels shrink and
waste away and the scar becomes whiter even than the adjacent skin. This
occurs also in the mucous membrane which remains pink for a considerable
time. The membrane in fact undergoes the first stage of inflammation
as a reaction to the injury it has sustained. The blood vessels become
enormously dilated, and its blood supply increased. It presents the best
conditions for healing along the edges where it has been torn, but the
whole of its outer surface also, which, after reflection becomes opposed
to the raw surface between the corona and the cut foreskin inferiorly,
becomes united by a similar process to this raw area.
In those cases where the reflection of the mucous membrane has not been
perfect a gap will be left between its margin and the cut foreskin, in
which healing takes place by _granulation or second intention_.
Public-domain text, read in full here on John Shaqi.
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