Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
Before using, the bandage should be rolled up very tightly, so that it
may be grasped easily and held in the hand firmly without slipping. In
putting it on, unwind only that portion which is being applied to the
limb, because if it be loose in the hand, or if a considerable piece
be unrolled at a time, it cannot be applied firmly or smoothly. The
bandage should always be carried up to the knee, even if the ulcer or
wound be seated on the lower part of the leg or on the foot itself, as
the object of its application is not merely to cover the ulcer but
also to support the vessels of the limb. If the bandage be
discontinued on any part of the leg, it is liable to become loose and
fall down.
It is desirable also that the patient should not wear a garter above
the bandage, as anything unequally tight in the course of the veins is
calculated to obstruct the free passage of the blood.
The firmness with which the bandage is put on is, of course, chiefly
for the purpose of gaining the good effects of compression on the
structures beneath, but besides, it contributes very much in making
the bandage remain in its position when applied. Encircle the limb
with it in a loose, careless manner, and it will fall down almost
immediately the patient begins to walk about. Tight bandaging is
extremely well borne if performed in a complete and methodical way,
beginning at the lowest portion of the foot around the first joints of
the toes and ending just below the knee.
The proper application of the bandage is of such great importance,
especially in the treatment of varicose ulcers of the leg, that it
should, when possible, always be done by the doctor himself. It is
difficult for the most skilled layman to put a bandage on his own leg.
The real practical difficulty lies with those patients who live at a
distance from the doctor and who can only visit him once a week or at
ten day intervals. These must be taught to dress and bandage the
limb, and generally some friend or relative will learn to superintend
the details.
The length of time which elapses before the bandage and dressings are
removed and reapplied must necessarily be determined by the
circumstances of each case. When the ulcer is very extensive and the
discharge proportionately great, it may be advisable to dress the leg
every day at the beginning of the treatment. Generally speaking, an
ulcer of the leg is disturbed too often. To take off a dressing and
put on another, even though done with the greatest care, interrupts
the healing process and the natural steps to cure. Let the dressing
remain on until some uneasiness points to the propriety of taking it
off, for the purpose of allowing the escape of the discharge. Delay
the removal of the dressings as long as possible without carrying the
forbearance too far. Avoid extremes of waiting too long or of meddling
too soon. Taking the average case, an interval of three days may in
general be safely permitted.
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