Quotation from: Manual of SurgeryWritten by: Alexander Miles and Alexis Thomson |
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_In superficial bones_, such as the sternum, the formation of tuberculous granulation tissue in the deeper layer of the periosteum, and its subsequent caseation and liquefaction, is attended by the insidious development of a doughy swelling, which is not as a rule painful, although tender on pressure. While the swelling often remains quiescent for some time, it tends to increase in size, to become boggy or fluctuating, and to assume the characters of a cold abscess. The pus perforates the fibrous layer of the periosteum, invading and infecting the overlying soft parts, its spread being influenced by the anatomical arrangement of the tissues. The size of the abscess affords no indication of the extent of the bone lesion from which it originates. As the abscess reaches the surface, the skin becomes of a dusky red or livid colour, is gradually thinned out, and finally sloughs, forming a sinus. A probe passed into the sinus strikes carious bone. Small sequestra may be found embedded in the granulation tissue. The sinus persists as long as any active tubercle remains in the tissues, and is apt to form an avenue for pyogenic infection.
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