The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
The surface to which these grafts are applied must be thoroughly
cleansed as well as the surface from which they are removed. If an
ulcerated surface is to be prepared for grafting it should be scraped
thoroughly with a sharp spoon; all sloughing or suspicious tissue
should be carefully removed, and all oozing allowed to subside. Not
until the surface is prepared is it advisable to remove the grafts.
These are best removed by putting upon the stretch the skin of the
selected area, so as to render it taut and as nearly flat as possible.
The razor used for the purpose should be sterilized and sharp. Salt
solution may be allowed to drip upon the razor while the surgeon is
using it. It is rarely practicable to remove a strip over 5 Cm. wide
or 25 Cm. long. The endeavor should be to remove only the superficial
layer of the skin, and when properly done this removal should be
followed by but a trifling oozing of blood. If bleeding be profuse
the layer removed has been too thick. Grafts of sufficient number and
size are removed to nearly cover the desired area. The more completely
it is covered the more acceptable will be the final appearance of the
surface. If the grafts adhere, we may confidently rely upon their
furnishing enough fresh epithelium to fill in the irregular defects
between the edges. The grafts when cut should be raised with a razor
and a spatula and gently spread out upon the prepared surface, and so
pressed and treated that no air bubbles are retained beneath them. If
the surface be dry enough they will adhere to the very thin coagulum of
blood which glazes it, and after a few moments it will take friction to
disturb them.
Should the margin of the surface to be grafted be old and indurated it
is best to trim off any depression that exists, so that the new skin
may not be let in below the surface of the surrounding skin.
The _dressing_ should consist of a layer of sterilized oiled silk,
gutta-percha tissue, or green protective, laid on in strips, in order
that excessive fluid may escape between them. A little antiseptic
powder may be dusted upon the grafts, if such be the choice of the
surgeon, but if the operation has been properly managed this will
hardly be necessary. Careful regulated pressure should be made outside
of the protective, by cotton and a suitable dressing, and then the
part, if a limb, may be bound upon a splint in order to ensure
physiological rest. _Silver, tin, or aluminum foil_ also make a good
protective, and, on theoretical principles, are even better than the
textile materials.
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