Surgery, with Special Reference to Podiatry — John Shaqi
Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Cleaning the Wound.+ If the surface is hairy it must be shaved before
the scrubbing. An accidental wound is infected and must be well washed
out with an antiseptic solution. A clean wound, made by the surgeon,
need not be irrigated, in fact, irrigation with an antiseptic fluid
leads to necrosis of tissues, causes a profuse flow of serum and
necessitates drainage. If clots have gathered in a wound, they must be
removed, as their presence will prevent accurate coaptation of the
edges. In an infected wound, they are washed out with a stream of
corrosive sublimate solution. In a clean wound, they are washed out
with hot salt solution. If dirt is ground into a wound, as is often
seen in crushes, pour sweet oil into the wound, rub it into the
tissues, and scrub the wound with ethereal soap. The oil entangles the
dirt and the soap and water remove both dirt and oil. After the rough
cleansing, irrigate with corrosive sublimate solution. In some cases,
especially in bone injuries, it is necessary to scrape the wound with
a curet.
A granulating wound is treated the same as an ulcer and the treatment
is discussed under that chapter.
+Drainage, Closure and Dressing.+ Superficial wounds require no special
drain, as some exudate will find exit between the stitches and the
rest will be absorbed. A large or deep wound requires free drainage
for at least twenty-four hours by means of a tube, strands of horse
hair, silk, catgut or gauze. An infected wound must invariably be
drained. Good drainage largely compensates for imperfect antisepsis.
If capillary drains be employed, apply a moist dressing. Divided
nerves and tendons must be sutured. Close the edges with silk sutures
or silkworm gut if the wound is deep and tension inevitable. Catgut is
used for superficial wounds and for those where tension is slight. The
interrupted suture is, as a rule, the best. If the wound is infected,
dress with antiseptic gauze; with aseptic or antiseptic gauze if it is
not infected. A dry dressing absorbs wound fluids quickly and is less
likely to become infected. Change the dressings in twenty-four hours
or sooner if they become soaked with the discharge. After this, in an
aseptic wound the dressing need not be changed for days. If pus forms,
open the wound at once.
+Rest and Constitutional Treatment.+ In planning the treatment of wounds
the most careful consideration for securing physiologic rest should be
had. If at or near a joint, the parts both above and below should be
immobilized. In whatever part of the body, physiologic rest should be
secured as nearly as possible. If the wound be of the leg or foot, the
patient should be in the recumbent position, with the part elevated
and a splint applied. The factor of rest, next to that of cleansing
and dressing, is most important. Physiologic rest means not only less
pain, less reaction, but a more rapid and certain repair.
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