Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
The two cardinal rules to be observed in the application of the
bandage are: (1) absolutely no pain with the application of the
bandage; (2) the pulse at all times must be felt below the bandage.
In cases which require the bandage to remain in place from sixteen to
twenty hours each day, it will be necessary to first apply a soft
flannel bandage underneath the rubber one in order to prevent pressure
necrosis.
Frequently changing the location of the bandage up and down the
extremity, and treating the skin with alcohol rubs, will also be
helpful to patients with a tender skin. The elastic bandage must
always be placed upon a healthy area, proximal to the diseased part.
All dressings should be removed while the compressing bandage is on,
in order that the part may become hyperemic.
Wounds or sinuses are covered with sterile gauze and kept in place
with a towel, fastened with a few safety pins.
In acute inflammation, septic wounds and phlegmons, the increased
inflammation is apt to frighten the beginner, but this is a desired
phase of the treatment.
As a prophylatic against infection, it cleanses the wound, produces a
local immunization and reaction before the infection has a chance to
work; the earlier the bandage is applied the more remarkable is the
effect.
For incised wounds of the foot with division of the muscles and
tendons, if the tissues are not too seriously injured, the muscles and
tendons should be united and the skin closed with interrupted sutures
sufficiently far apart to allow free excretion. No drainage is
employed and a slight compressing dressing is applied. The elastic
bandage is applied very lightly, producing only a slight venous
engorgement and the bandage should remain on from ten to eighteen
hours a day.
As soon us the symptoms of acute inflammation subside, the time of
application of the bandage is reduced. If signs of suppuration are
present, the wound should be promptly opened and the pus evacuated.
The knife takes care of the pus; hyperemic treatment fights the
infection.
In gonorrhoeal arthritis of acute or chronic nature, and in cases of
tuberculosis of the bones and joints, the passive form of hyperemia is
especially indicated.
The use of cupping glasses is limited to abscesses, furuncles and
sinuses.
+Active Hyperemia+, or arterial hyperemia, is produced by means of
hot-air boxes such as the Tyrnauer electric apparatus, or the gas
apparatus of Betz.
Active hyperemia increases the arterial blood to any part of the body,
thus favoring the absorption of chronic exudates, infiltrates,
adhesions, etc. Dry, hot air permits the use of a high degree of
temperature without injury or pain to the respective part.
For neuritis of the foot, ulcers, especially diabetic, perforating and
varicose, and for the stiffness following a chronic inflammation, or
after a fracture, the arterial form of hyperemia gives good results.
+COLD+
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