The healing of arteries after ligature in man and animals / by J. Collins Warren.

  • Warren, John Collins, 1842-1927.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: The healing of arteries after ligature in man and animals / by J. Collins Warren. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    subclavian artery, and in a specimen of the carotid artery prepared in such a v\^ay as to show the callus. While the callus has been enlarging, its cells have infiltrated the outer fibres of the adventitia, and they gradually disintegrate and absorb the bundle of fibres held by the ligature, which now lies en- closed by a wall of granulation cells on all sides. The walls of the vessel have now completely separated from one another, but form at each end a firmly closed cul-de-sac, which still shuts out all external growth. (Frontispiece, Fig. I.) As two weeks have elapsed by this time, it is not unnatural that observers should have supposed that union had taken place, but in reality we are only approaching the beginning of the second stage of the process. The ligature, which is now entirely independent of the vessel, becomes encysted; or, if it be made of material that is easily absorbed, is found infiltrated with granulation cells, or it may have disappeared entirely. Under the old system' of leaving one end of the ligature protruding from the wound, it would by this time have become sufficiently detached from the tissues, which it had originally surrounded, to enable the surgeon to withdraw it, provided the callus did not hold the knot too firmly in its grasp. Occasionally the suppuration would be sufficient to discharge it through an open sinus, as seen in the Frontispiece (Fig. II.). Strictly speaking, the ligature does not ulcerate through the walls of the vessels, as an elastic ligature does through tissues which it encloses. Having constricted the adventitia into a tendinous- like band at the moment of its application, it remains encircling this tissue like a ring upon the finger. The softening of the vessel-wall is accomplished by the granulation cells, and this process is really more m.arked after the ligature has separated entirely from the vessel. The sole function of the ligature, after it has closed the vessel, is to keep the walls from expanding until they are held sufficiently firmly by the callus. During the third week, the granulation tissue has so infiltrated the inner and middle coats of the vessel at the point where they were drawn together by the ligature, that they retract slightly, and allow the granulation tissue to insert itself between them, and to invade the interior of the vessel. This is a somewhat critical period in the process of repair, for, if there has been a softening of the callus by suppuration, it may not be sufficiently strong to restrain this retraction and the thrombus maybe forced out (Fig. 14) unless it be firmly secured to the vessel-wall by the process alluded to above.