Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
After the layer of granulations has been removed and the newly healed
edge of the ulcer has been cut away, the bleeding must be arrested
completely before the grafts are applied. The most rapid method is to
pour a few drops of adrenalin chloride (1 to 1000) solution over the
raw surface, when the oozing ceases immediately. If adrenalin be not
at hand the following plan will be found satisfactory: any spouting
vessel is clamped and a large piece of sterilized gauze or thin sheet
rubber is applied over the raw surface of the wound; outside this,
several sponges are placed and a sterilized bandage is bound firmly
over them. If the sore be small and an assistant be available, he may
apply the pressure. Pressure is employed indirectly through the
protective in this way, because if it were made directly upon the
surface of the wound by means of the sponges, bleeding would
recommence when the latter were removed, as they stick to the raw
surface.
While the bleeding is being arrested the surgeon cuts his skin grafts
from any part of the body, as he thinks fit As a rule they are taken
from the front of the thigh, but the side of the abdomen may be
selected. The area from which the grafts are to be cut is disinfected,
and the surgeon grasps the limb from behind with his left hand in such
a way as to make the skin over the front of the thigh as tense as
possible; in doing this he pushes the soft parts well forward so as to
make the anterior aspect of the limb as flat as possible. The skin is
further put on the stretch vertically by an assistant, who pulls it
upward and downward. These precautions are important, as without them
it is almost impossible to cut a graft of even width. The razor, which
should have a very broad blade, is dipped into a boric acid solution
and is kept constantly wet with it whilst the grafts are being cut.
Unless this be done, the graft adheres to the blade and may be either
partially or wholly cut through before a sufficient length can be
obtained. The razor is made to penetrate through about half the
thickness of the skin, and then, by a lateral sawing motion, the
grafts are cut as broad and as long as possible. After a little
practice it is easy to cut them about two inches in breadth and about
four or five inches in length.
If one graft be insufficient, it is best to slide it off the razor and
leave it on the bleeding surface; in this way it is kept warm and
moist. Some surgeons put the graft into warm saline solution, and it
is said to then spread out more easily afterwards. Small skin grafts
can be cut under local anesthesia.
+Application of Grafts.+ When a sufficient number of grafts have been
cut, the bandage, sponges and protective are removed from the raw
surface of the ulcer and the grafts are applied to it if the bleeding
has stopped, as is generally the case. The raw surface usually has a
thin layer of blood-clot upon it, and this should be wiped away.
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