SPECIAL TREATMENT OF WOUNDS 



411 



to mean the entire surfaces of the divided parts, and not merely the 

 outer edges or lips; for unless perfect coaptation of the more deeply 

 seated parts is effected, any serum which may exude from the divided 

 surfaces will gravitate to the bottom, and by increasing in amount tend 

 to force the parts asunder and prevent healing; besides which it serves 

 as a breeding-ground for micro-organisms should the wound prove not 

 to be aseptic. 



When the wound is of no considerable depth, but little difficulty will 

 be experienced in effecting complete apposition of the divided structures; 

 but in dealing with deep wounds special care and special methods of 

 retention will require to be resorted to. In either case, the 

 edges of the wound must be brought together by silk, wire, or 

 catgut suture (pp. 416, 417), interrupted or continuous, as may be 

 deemed desirable, and after the hairless surface has been freely 

 sponged with carbolic solution, the wound must receive its per- 

 manent antiseptic dressing. Of the various substances employed 

 for this purpose, the double cyanide of mercury and zinc gauze 

 introduced by Lord Lister some years ago is regarded by our 

 best surgeons as the most efficient and reliable. Before being 

 used, it is wrung out in, or moistened with, a solution of carbolic 

 acid (1 in 40) or corrosive sublimate (1 in 4000), and then 

 applied over the wound, and for some distance around it. In 

 this connection it should be pointed out that merely to cover 

 the wound itself is to run oreat risk of failure by exiwsing it ^s-"'-^- 



c> _ . Drain.ige- 



to attack from organisms which may obtain access from without. Tube 

 and defeat the object in view. Over this first layer of gauze 

 four, five, or six others are placed, and these are covered by a thick layer 

 of sterilized wool. Where practicable, a light bandage should be applied 

 on the whole, so as to bring slight pressure to bear in maintaining com- 

 plete apposition of the divided parts. 



In deep incised wounds gravitation of blood and serosity to the more 

 depending parts, leading to the formation of a cavity or pocket, and 

 hindrance to healing, may take place, and will require to be provided 

 against. This may be done in some cases by the careful application of 

 pressure through the dressing, in others deep stitches will require to be 

 inserted in order to Ijring the deeper parts of the wound into apposition, 

 or a drainage-tube (fig. 412) must be inserted for a .short time to allow 

 for escape of any matter which may exude. 



If the wound has been rendered aseptic and protected from subse- 

 quent disturbance and contamination, complete healing should be effected 

 in from ten to fourteen days, when the dressing may be removed and 



