Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
If the skin edges are thickened and curled upon themselves, it may be
best to curette or to reduce them by cauterization, so stimulating
epitheliar spreading. Sterile gauze is then loosely laid upon the
surface, backed with a highly absorbing material, such at charpie
cotton (Burns), wood wool, and poplar sawdust, retained in gauze bags
(Porter). The absorbing layer should be light and pervious to the air,
to facilitate not only free absorption, but ready evaporation of the
secretions.
=Changing Dressings.=—All dressings must be absolutely sterile and all
precautions, as primarily carried out, must be followed in changing them.
It is rather infrequent to use permanent dressings in plastic surgery,
but where the wound appears aseptic, with a dry serous crust over the
line of healing, it should not be disturbed except for mechanical
reasons. The latter are caused by the coagulated mixture of the wound
secretion and the antiseptic powder used, often aggravated by the median
knotting of sutures or the careless disposition of the loose suture ends.
Not too much can be said of carefully folding the free silk suture ends
at right angles to the incisions. The ends, moistened subcutaneously,
are very liable to take on septic infection and communicate it to the
wound—crowded into the very wound. When becoming embodied in the coagula
of serum and antiseptic powder it prevents, by pressure, perfect union,
causing a wider scar at such point, as well as endangering the asepsis
of the wound by being pulled off accidentally, thus tearing it open and
bringing on hemorrhage.
The appearance of the resulting scar in facial surgery is often of as
much importance to the patient as the operation itself, therefore, all
care should be exercised in bringing about the very best result.
For this reason, a patient in poor health should not be operated upon,
and any erosion of the skin about the seat of operation should be
thoroughly healed before attempting plastic work. Aristol dusted on an
abrasion will heal it quickly.
If hemorrhage follows the dressings of a wound, the dressing should be
removed and the hemorrhage controlled by pressure, unless severe, and
be redressed. Moist blood decomposes readily and is a source of early
infection, unless careful drainage under antisepsis is established. At no
time should any part of the wound be unnecessarily exposed directly to
the air. For small wounds, silk protective plaster may be used to cover
the gauze dressing, while sterile gauze bandages should keep dressings of
large area in place.
Bandages, when changed, should be cut away with the aid of the
Lazarewitch angular bandage scissors and not be unwound. It is quicker
and the undue pulling of such, when glued by secretions, is liable to
disturb the healing of wounds and even result in the tearing out of
sutures.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account