Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
The essential feature of ambulatory treatment is a good dressing to
prevent congestion, and Unna’s paste is ideal for this purpose. The
paste necessary for the bandage is prepared as follows: first dissolve
four parts of the best gelatin in ten parts of water by means of a hot
water bath. While the fluid is hot add ten parts of glycerine and four
parts of powdered white oxide of zinc; stir briskly until the mixture
is cold. Another formula for the paste, and the one recommended,
consists of the following: white gelatin, 2-1/2 ounces; water, 8
ounces; zinc oxide, 2-1/2 ounces, and glycerine, 4 ounces; prepared as
above. The paste should always be melted before use by placing the
receptacle in a hot water bath or in an ordinary copper sterilizer,
such as that employed for boiling instruments. A small tin can be
used, and a piece of paste about four inches square is cut into fine
pieces and put in the can. This is placed in the sterilizer, into
which is poured water to a depth of about two inches, so that the can
is but slightly immersed. No top should be placed on the can. An
ordinary stove or gas range can be used for heating purposes. A very
important fact to remember is that no water is to be put into the can
with the paste.
The leg is next cleansed, and after the paste has been thoroughly
melted it is applied from the base of the toes to the knee, as hot as
the patient can comfortably tolerate it, by means of an ordinary small
paint-brush. Then a layer of gauze bandage (two to three inches in
width, according to the limb) is applied, then a layer of paste, and
in this manner two or three thicknesses of bandage are used, depending
on the case. In thin people, it is necessary to use only one or two
layers of bandage, whereas in stout persons several layers may be
required. After the last application of the paste, some non-absorbent
cotton is spread on the bandage, giving it the so-called “moleskin”
plaster finish. Another way of finishing the dressing is to dust some
ordinary talcum powder on the last layer of the paste, giving the
bandage the appearance of a plaster-of-Paris dressing. If there is an
ulcer, a window can be cut out, thus providing for the drainage of the
secretions. The length of time this dressing should be left on depends
on a number of conditions, especially the amount of secretion, and
whether the patient has to remain on his feet very much. Ordinarily,
the bandage can remain on for one week, but indications may be such
that it need not be removed sooner than the tenth day, and in some
instances it can be kept on for three or four weeks. To remove it, an
ordinary bandage-scissors is used to cut the dressing, and it peels
off without disturbing any of the granulations on the ulcer.
+PROMOTION OF NEW EPITHELIAL GROWTH AND CICATRIZATION+
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