Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The following group of antiseptics has been chosen with a view of giving
the best selection, to which the author has added a short description of
each, so that the surgeon may choose one or the other, as the occasion
may demand. As a rule, an operator cultivates the use of a certain line
of antisepsis, especially in this branch of surgery, experience being the
best guide; yet it is hoped he may find certain aid from those referred
to, their particular use being pointed out from time to time, as the
author has had occasion to prefer one or the other.
=Alcohol= (_absolute_).—This is a well-known antiseptic, but, because of
its ready evaporation, is especially used for the hands, as described,
and to cover sharp-edged instruments after sterilization.
=Aluminum Acetate= (_Bürow_, _H. Maas_).—A powerful, nontoxic antiseptic.
Is used only in two- to five-per-cent solution. According to Primer,
it arrests the development of schizomycetes, and in twenty-four hours
destroys their propagation. It readily removes offensive odors of wounds;
its great objections are that it injures the instruments, and, because
of its astringent nature, roughens the skin of the hands. This, however,
makes it particularly useful for sponging to arrest capillary oozing.
=Boric Acid= (_Lister_).—Not a powerful, but nonirritating, antiseptic.
For this reason it is used extensively in cleansing mucous membranes,
and, when associated with salicylic acid, as in the well-known Thiersch
solutions, composed of salicylic acid, 2 gms.; boric acid, 12 gms.;
water, 1,000 gms., is much used in skin-grafting operations. It is
not very soluble in cold, but readily in hot, water and alcohol. The
saturated solution is prepared by adding ℥j to the pint of boiling water.
=Benzoic Acid.=—Nonirritating, moderate antiseptic (Kraske); is prepared
in 1-250 solutions. Soluble in hot water and alcohol, but sparingly in
cold water.
=Carbolic Acid= (_Phenylic Acid_).—Not a powerful, but a much-used
antiseptic. The purest acid should be used. It appears as a colorless
crystalline solid, liquefied by the addition of five per cent water. If
more water is added the solution becomes turbid, clearing when 1-2,000 is
reached.
It is readily soluble in glycerin, alcohol, ether, and the fixed volatile
oils. Solutions in alcohol and oils have no antiseptic effect (Koch). The
1-20 aqueous solution is recommended by Lister.
The aqueous solutions used in surgery are 1-20 and 1-40. The weaker
is used for the operator’s hands, to cover instruments, as already
mentioned, and to impregnate sponges. The stronger solution is used
for the carbolic spray, to cleanse the unbroken skin about the site of
operation, and to disinfect wounds. Either solution, when applied to an
open wound, whitens the raw surface, coagulates the albumen, and causes
considerable irritation, which subsides quickly and is followed by
numbness.
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