Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Stage of Epidermis Covering.+ If skin grafting is not done, the new
epithelium can be renewed only from the edges—a slow process often
requiring months to cover the whole surface. Coincident with this
stage is the stage of cicatrization. The granulations which fill the
space left by the slough soon begin to contract—nature’s effort to
fill the gap. The granulations are irregular and abundant and for this
reason the scar resulting from a burn is irregular, uneven, inelastic,
contracted, distorted, protuberant and disfiguring.
+Duration.+ First degree burns get well in a few days; those of second
degree, in about from seven to fourteen days, and the healing of the
third degree burns depends upon their extent and depth, severe ones
requiring a very long time. As to scarring in a burn of the third
degree, you can always predict it, although this can be minimized by
early skin grafting.
+Treatment.+ The local treatment is to be directed toward the limitation
of the resulting inflammation; the prevention of septic infection;
assisting the normal elimination of the eschar; the development of
granulations and limitations of the deformity.
In burns of the first degree little or no treatment may be requisite;
a mild dusting powder such as boric acid or sodium bicarbonate may be
used, or picric acid in the strength of from half to one per cent.; a
5 per cent. boric acid ointment is also to be recommended.
Burns of the second and third degree require a different treatment.
Suppose we are called to treat a severe burn of the second or third
degree and find the patient suffering agonizing pain with oncoming
shock and a chill. At once administer a hypodermic of one quarter to
one half a grain of morphine; 1-40, to 1-20 grain of strychnine; and 1
to 1-100 or 1 to 1-50 grain of atropine. To stop the pain and combat
shock, have the room warm, clear it of unnecessary furniture; order
hot water bottles, and, if necessary, give a hypodermoclysis or a
Murphy enema.
In a severe burn three things are more important than the local
treatment: (1) to stop the pain; (2) to combat shock; (3) to provide
for dilution and elimination of the toxins, which are thrown into the
blood.
After having carried out the instructions given above, then proceed to
do the local dressing. The clothing should be carefully cut away—never
pulled off, or dragged over the burned area. A burn is at first
sterile, and we must try to keep it so. Unless we believe that it has
become infected through dirty handling, or by having had dirty
clothing dragged over it, or a dirty blanket laid on it, it is best
not to wash the burn. Pieces of gauze of necessary size are now spread
thickly with an ointment and applied somewhat beyond the burned
areas; over this cotton, and over all a bandage.
The patient is now put to bed, and if shock continues, the normal salt
solution is repeated every eight hours and the patient is given plenty
of water to drink.
Public-domain text, read in full here on John Shaqi.
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