104 WOUND TREATMENT 



than the fact that they are very certain to occur in a 

 large percentage of cases. 



To better illustrate this point, the prevailing contro- 

 versy in the medical profession over the open treatment 

 of fractures might be mentioned to advantage. During 

 the last few years the old, time-honored method of treat- 

 ing fractures of long bones by simple reposition and 

 retention has been discarded by many surgeons for the 

 new open method. That is, an invading incision was 

 made into the traumatic cavity and the segments fitted 

 together and retained with screws, nails, or plates. With 

 asepsis as a protection against complications, it at first 

 seemed this apparently sensible method would soon be- 

 come the universal one for the treatment of fractures. 

 Subsequent developments, however, proved that the plan 

 was not entirely harmless. Many cases became infected 

 with disastrous results. Why? Because a fracture with 

 its injured tissues, blood-clots, outpoured serum, and im- 

 paired circulation is a favorable field for infection. 

 To-day, on this account alone, the open method is being 

 abandoned except in special cases. In veterinary prac- 

 tice the wound of castration might be used to illustrate 

 the same point. The crushed spermatic cord, the accumu- 

 lated clot and serum, and the closed incision combine 

 conditions especially favorable for microbian growth. In 

 fact, if any bacteria are deposited they are prone to 

 develop a serious infection very rapidly. 



We must, therefore, plan as perfect a system of drain- 

 age as possible in all wounds of this class, for otherwise 

 our other good work will be useless. During the trim- 

 ming process — that is, the mechanical disinfection re- 

 ferred to in the preceding paragraph — special care is 

 taken to groove channels toward the proposed drainage 

 orifice. This done, the skin flap is ready to be sutured. 



