Plastic and cosmetic surgeryKolle, Frederick Strange
Science
Plastic and cosmetic surgery
Kolle, Frederick Strange
Surgery, Plastic
If the symptoms are not relieved promptly the indications of septicemia
assert themselves with an increasing temperature, between 102° and 104°
F., with a rapid compressible pulse gradually becoming weaker. The
respirations are rapid and shallow. The tongue becomes dry and discolored
and the teeth are covered with sordes.
The restlessness disappears and apathy, somnolence, and a low type of
delirium takes its place. Vomiting occurs. There may be a profuse
diarrhea and the urine is passed involuntarily. In other words,
septicemia is but an aggravated continuance of inflammatory fever;
untoward symptoms may come on early, and death may result within
forty-eight hours.
On inspection, the infected wound appears highly inflamed, there is
increasing swelling, with more or less pain in the part. The edges of the
wound appear pale and everted. Serous oozing comes from the wound. If
sloughing is to occur from tension or low vitality of the parts the area
becomes discolored, assuming at first a pale green color, which turns
into bluish brown—and, lastly, brown.
=Treatment.=—The treatment of such wounds is to immediately relieve all
tension by withdrawing the sutures. Flush the wound with peroxid solution
and irrigate thoroughly with a 1-3,000 bichlorid solution, leaving the
wound open for a free drainage.
Then apply iodoform gauze over the wound and change the dressings as
often as is deemed necessary—two or three times a day. In severe cases
open the wound thoroughly, even by further incision, clean out the
contents of the wound, such as foreign matter, bloodclots, exudate, or
perhaps pieces of bone that may have been overlooked, using a small,
sharp spoon curette for the purpose. See that the deeper recesses of the
wound, especially in those about the nasal bones, are thoroughly gone
over.
Next irrigate the wound with a 1-1,000 bichlorid solution. Carbolic
solutions to be of use in the severer cases, are too irritating and
cause an increase of the secretions, hence they are not to be used.
Furthermore, their toxic property is not desirable and ofttimes are not
well borne by the patient.
The wound is now loosely filled (not packed) with iodoform gauze to
permit of perfect drainage. Aseptic absorbent cotton may be placed over
this.
It is not advisable to bring the edges of the wound together; the main
object is to overcome the spread of infection and the toxic absorption of
the wound product.
When the symptoms are severe moist dressings, in the form of compresses
dipped into 1-3,000 bichlorid, are to be preferred, changing them every
hour.
Internally it becomes necessary to reduce the temperature and to overcome
the toxemia.
Public-domain text, read in full here on John Shaqi.
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