Surgery.

Date:: [1913]

Credit: Surgery. Source: Wellcome Collection.

30/412 page 22

$99 jLIjLi (b) Lacerated or contused are produced by tearing or dragging forms of violence, as in machinery accidents. There is great irregularity of the surface and edges, and a comparative absence of bleeding. Shock is often a marked feature. (c) Punctured.—In this variety of wound the depth is greater than the length or breadth. They are especially dangerous, as organisms are carried deeply into the tissues, large blood-vessels may be incompletely divided, and viscera may be perforated. How are Accidental Open Wounds dealt with ? (a) Arrest of haemorrhage. (b) Cleansing. (c) Examination. (d) Treatment of the wound. Arrest of Haemorrhage.—As a temporary measure pressure must be applied. This can be done over the site of bleeding either digitally or by a pad firmly bandaged round the part. Where a large artery in a limb has been severed a tourniquet may be necessary to control the bleeding until the vessel can be secured. For the permanent arrest of haemorrhage, small vessels can be secured with artery forceps and torsion employed. Large vessels should be ligated or sutured accord- ing to the degree of damage. Hot water, to which a little adrenalin has been added, is useful for oozing. Cleansing.—Cover the wound with an aseptic dressing, and clean the surrounding area. Hairy parts must be shaved ; the skin is scrubbed with soap and water and painted with tincture of iodine. Now expose the wound and cleanse it. Examination.—Note the extent and depth of the wound, the presence or absence of foreign bodies, damage to blood- vessels, nerves, or tendons, fracture of the underlying or neighbouring bones, and when in the vicinity of a joint, if the joint has been penetrated. Treatment of the Wound.—The skin edges are excised, using a sharp scalpel, thus removing the devitalised and infected tissue—debridement. The remainder of the wound$

Surgery.

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