Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
The earlier the wound is disinfected the greater is the possibility of
diminishing this risk. If cleansing is carried out within the first six
hours the chance of eliminating sepsis is good; with every succeeding
six hours it diminishes, until after twenty-four hours it is seldom
possible to do more than mitigate sepsis. (J. T. Morrison.)
The presence of a metallic foreign body having been determined and its
position localised by means of the X-rays, all devitalised and
contaminated tissue is excised, the foreign material, _e.g._, a missile,
fragments of clothing, gravel and blood-clot, removed, the wound
purified with antiseptics and closed or drained according to
circumstances.
#Pistol-shot Wounds.#--Wounds inflicted by pistols, revolvers, and small
air-guns are of frequent occurrence in civil practice, the weapon being
discharged usually by accident, but frequently with suicidal, and
sometimes with homicidal intent.
With all calibres and at all ranges, except actual contact, the wound of
entrance is smaller than the bullet. If the weapon is discharged within
a foot of the body, the skin surrounding the wound is usually stained
with powder and burned, and the hair singed. At ranges varying from six
inches to thirty feet, grains of powder may be found embedded in the
skin or lying loose on the surface, the greater the range the wider
being the area of spread. When black powder is used, the embedded grains
usually leave a permanent bluish-black tattooing of the skin. When the
weapon is placed in contact with the skin, the subcutaneous tissues are
lacerated over an area of two or three inches around the opening made by
the bullet and smoke and powder-staining and scorching are more marked
than at longer ranges.
When the bullet perforates, the exit wound is usually larger and more
extensively lacerated than the wound of entrance. Its margins are as a
rule everted, and it shows no marks of flame, smoke, or powder. These
features are common to all perforations caused by bullets.
Pistol wounds only produce dangerous effects when fired at close range,
and when the cavities of the skull, the thorax, or the abdomen are
implicated. In the abdomen a lethal injury may readily be caused even by
pistols of the "toy" order. These injuries will be described with
regional surgery.
Pistol-shot wounds of _joints_ and _soft parts_ are seldom of serious
import apart from the risk of hæmorrhage and of infection.
_Treatment._--The treatment of wounds of the soft parts consists in
purifying the wounds of entrance and exit and the surrounding skin, and
in providing for drainage if this is indicated.
There being no urgency for the removal of the bullet, time should be
taken to have it localised by the X-rays, preferably by stereoscopic
plates. In some cases it is not necessary to remove the bullet.
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