90 



OPERATIVE TECHNIQUE. 



disadvantage of producing superficial necrosis. Provided there is no 

 infection, simple boiled water, or water containing a little common 

 salt, is sufficient. When arterioles or small veins are cut, they can be 

 picked up with forceps and ligatured with silk or catgut. In most 

 inflamed tissues haemorrhage is abundant, even when no large vessel 

 has been cut. In such case the thermo-cautery is sometimes useful ; 

 by passing it at a red heat lightly over the lips of the wound bleeding is 

 checked. The thin aseptic scar thus produced does not necessarily 

 prevent union by primary intention, as it may be completely absorbed. 

 The same is true of ligatures left in wounds. Catgut is digested by 



the tissues, or destro3'ed in a few 

 days by large migrating cells, 

 and by the new cell elements ; 

 silk becomes encysted, and is 

 slowly absorbed. 



To obtain primary union, 

 the wound must be scrupulously 

 guarded against infection. All 

 bleeding must be stopped, and 

 the tissues brought exactly into 

 apposition. A thin layer of 

 blood in an aseptic condition 

 between the lips of the wound 

 does not prevent primary union ; 

 the tissues tolerate it, and it is 

 even utilised in the process of 

 repair ; but large clots are 

 absorbed with difficulty, and 

 present a very favourable soil 

 for the growth of pathogenic 



Fig. 91. — Portable irrigator. 



microbes. The bleeding surfaces are dried as far as possible, 

 covered with antiseptic vaseline [vaseline 50, powdered boric acid 

 5, iodoform i], closely approximated throughout their extent, i.e. 

 both superficially and deeply, and every effort made to secure 

 contact. When coaptation is not perfect in the depth of the 

 wound, a space is left for the accumulation of blood and serosity, 

 in which any retained germs multiply rapidly. Where the wound 

 implicates several different laj^ers, it may become necessary, in order 

 to keep these closely in apposition, to pass a number of deep sutures 

 of catgut or silk fixed at their extremities to little rolls of gauze [deep 

 or anti-tension sutures], in addition to inserting superficial sutures of 

 silk or silkworm ligature. Lastly, the surface is washed with sublimate 



I 



