Manual of Surgery Volume First: General Surgery. Sixth Edition.Thomson, Alexis
Science
Manual of Surgery Volume First: General Surgery. Sixth Edition.
Thomson, Alexis
Surgery
_Ulcers in a callous condition_ call for treatment in three
directions--(1) The infective element must be eliminated. When the ulcer
is foul, relays of charcoal poultices (three parts of linseed meal to
one of charcoal), maintained for thirty-six to forty-eight hours, are
useful as a preliminary step. The base of the ulcer and the thickened
edges should then be freely scraped with a sharp spoon, and the
resulting raw surface sponged over with undiluted carbolic acid or
iodine, after which an antiseptic dressing is applied, and changed daily
till healthy granulations appear. (2) The venous return must be
facilitated by elevation of the limb and massage. (3) The induration of
the surrounding parts must be got rid of before contraction of the sore
is possible. For this purpose the free application of blisters, as first
recommended by Syme, leaves little to be desired. Liquor epispasticus
painted over the parts, or a large fly-blister (emplastrum cantharidis)
applied all round the ulcer, speedily disperses the inflammatory
products which cause the induration. The use of elastic pressure or of
strapping, of hot-air baths, or the making of multiple incisions in the
skin around the ulcer, fulfils the same object.
As soon as the ulcer assumes the characters of a healing sore, it should
be covered with skin-grafts, which furnish a much better cicatrix than
that which forms when the ulcer is allowed to heal without such aid.
A more radical method of treatment consists in excising the whole
ulcer, including its edges and about a quarter of an inch of the
surrounding tissue, as well as the underlying fibrous tissue, and
grafting the raw surface.
_Ambulatory Treatment._--When the circumstances of the patient forbid
his lying up in bed, the healing of the ulcer is much delayed. He should
be instructed to take every possible opportunity of placing the limb in
an elevated position, and must constantly wear a firm bandage of
_elastic webbing_. This webbing is porous and admits of evaporation of
the skin and wound secretions--an advantage it has over Martin's rubber
bandage. The bandage should extend from the toes to well above the knee,
and should always be applied while the patient is in the recumbent
position with the leg elevated, preferably before getting out of bed in
the morning. Additional support is given to the veins if the bandage is
applied as a figure of eight.
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