Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
When applied, it should be moistened with an antiseptic solution only.
This can be applied only to dry surfaces, however, and should be rarely
used, since subsequent hemorrhage or oozing will raise the plasters,
inviting sepsis.
It is better, however, in all cases to employ several layers of an
antiseptic gauze, such as fifteen-per-cent iodoform or boric-acid gauze
to cover the wound, and back it with absorbent cotton, over which a
bandage or the silk protective is applied to retain it. The gauze absorbs
the secretions, at the same time rendering them harmless.
At no time should cotton be placed next to the wound, as it forms a hard
mass with the secretions, the removal of which requires enough force to
injure or hazard the union of a new wound. Nor should a plaster dressing
be pulled off without thoroughly moistening it first, withdrawing the
various layers one by one. The gauze, when moistened, readily leaves the
wound without injurious traction. An excellent dressing for small, dry
wounds, and one that causes little tension, is collodium, or, better,
iodoform-collodium painted over the surface. The latter may be prepared
as follows;
℞ Iodoformum 5j;
Collodium 5x.
[Küster.]
To this may be added oil of turpentine or castor oil, which permits of
greater flexibility. Boric lint, applied wet, is also good. It must be
moistened thoroughly before removal. Larger wounds should be dusted over
with one of the powders mentioned and covered with folds of gauze and
absorbent cotton, held in place with gauze bandages.
Such dressings are allowed to remain until the sutures are taken out,
unless there is sign of soiling. As these secretions readily decompose,
it is best to remove the cotton and upper layers of gauze and renew them
every day, or as often as is necessary. The wound, in this way, is not
disturbed whatever, and the antiseptic properties of the lower fold of
gauze is sufficient to keep the wound surface clean.
In most superficial wounds it is best to remove the sutures at the end of
forty-eight hours, unless there are reasons for retaining them longer,
as the coapted surfaces are then sufficiently united to permit of other
dressings, such as aseptic plaster, now extensively used. Before these
are applied the skin is washed with alcohol or ether to assure a dry
surface to facilitate adhesion.
Sutures drawn as stated leave no possibility of stitch scars and reduce
the occurrence of possible stitch abscess to a minimum. As there is
always slight oozing following their removal, aristol or iodol may be
powdered over them before applying the plasters. This brings us to the
rather late question of sutureless coaptation of superficial incisions.
=Sutureless Coaptation.=—This method, first practically demonstrated by
_Bretz_, may be used with considerable advantage in wounds about the
face, and overcomes the strain of individual sutures, besides avoiding
the possibilities of stitch infection.
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