Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
The patient should never be intrusted to dress wounds himself. In cases
where the dressings cannot be changed frequently proper precautions for
drainage and comfort must be observed. The temperature of the patient
should be taken twice daily; any elevation thereof may indicate septic
infection and demand immediate attention.
When a portion of the ear, nose, or lip has been severed by injury, the
part may be put back into place and held by sutures and aseptic Z. O.
strips, powdered with aristol and properly dressed. Union usually takes
place, even in the most unexpected cases. None but incised wounds of
such nature should be covered hermetically with collodium or plaster,
as bruised surfaces so often in this kind of injury require perfect
drainage. The retention of secretions produces infection, generally
resulting in the entire loss of the part.
=Wounds of the Mucous Membrane.=—Wounds of the mucous membrane should be
carefully drained and cleansed freely at frequent intervals, especially
those about the mouth. Wounds of the cheek, if including the mucous
membrane, should be especially cared for, as there is here the increased
danger of infections from the secretions of the mouth.
=Pedunculated Flaps.=—When pedunculated flaps are left free of other
attachment, for reasons later mentioned, they must be dressed as
granulating wounds. Here it becomes necessary to support the loose
piece of skin in such a way as to overcome circulatory obliteration.
Unnecessary handling is always to be avoided. The following method has
been used with the best results by the author.
The flap is not dressed until all hemorrhage has ceased. A small pad
of sterilized or borated absorbent cotton is covered lightly with
ten-per-cent iodoform gauze—cigarette fashion. The surface of this roll
drain is powdered well with aristol or iodol and it is gently placed
beneath the flap so that it rests easily upon the same. A second and
somewhat larger pad or roll of like construction is placed next to the
skin surface of the flap. This is held in position by silk protective
plaster or several layers of gauze bandage, gently, though snugly,
applied.
The flap thus dressed should not be subjected to pressure, often
requiring considerable care on the part of the patient, especially during
the night. Undue pressure will induce sloughing and must be avoided, even
at the expense of comfort to the patient.
This dressing may be changed the second day, when the flap will appear
anemic. Signs of discoloration indicate gangrene, which is difficult to
overcome. In a short time the skin takes on a pale pink color, which
indicates a reëstablishment of circulation, and granulations begin to
show themselves on the reverse side, which, as they multiply, soon
thicken the flap sufficiently for the purpose desired.
Public-domain text, read in full here on John Shaqi.
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