Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
Each graft is lifted with forceps or the fingers and applied with the
cut surface downward, and then is carefully unfolded by means of two
probes and stretched evenly over the surface. The grafts should
overlap the edges of the skin and also each other, so that no part of
the raw surface is left exposed, for granulations always spring up on
the uncovered parts and are apt to destroy the grafts in their
vicinity; moreover, a thin scar is left at these points which may
break down subsequently. The graft is always thinner at its edges than
at its centre, and it is these thin edges which overlap each other or
the margin of the skin; there is no real sloughing of these
overlapping portions.
The dressing should be left on the grafted surface for about five
days; in some cases even for a week. If the wound be aseptic, no
suppuration or decomposition takes place beneath it. Before being
removed, the dressing should be thoroughly soaked with a 1 in 2500
sublimate solution, for otherwise it may stick at the edge and adhere
to the graft, which may thus be peeled off, unless great care is
taken. The parts should be gently cleansed with the same solution, and
a dressing similar to that put on originally should be employed for
about another week. At the end of that time the grafts are fairly,
firmly adherent and then a 5 per cent, boric acid ointment is the best
application.
It will be found that even at the first dressings the grafts present a
pink color and are adherent to the deeper surface, though they are
still readily detachable. In the course of about a week the old
cuticle peels off, but no raw surface is left. Later on, there is a
great tendency to the formation of new epithelium, cornification, and
drying-up, and it is to avoid the latter condition that ointments are
so useful; in fact, until the scar is absolutely sound, it is well to
keep the surface covered with some greasy application, the best being
the 5 per cent, boric acid ointment.
For many months the grafted surface is likely to scale or crack, and
this might prove a starting-point for the occurrence of sepsis which
would cause the newly grafted area to slough. It is important to keep
the scar as supple as possible, and therefore it should be constantly
anointed with cold cream, vaselin, or lanolin. Grafted surfaces upon
the face, however, do not manifest this tendency for any length of
time.
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