84 



DISIM-'KCTION AFTER OPERATION. 



but from the point of vievi of antisepsis the superiority of compresses 

 cannot be gainsaid. 



In all operations 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 serviceable in 

 the process of repair ; but large clots are harmful 

 and present a very favourable soil for the growth 

 of pathogenic microbes. The bleeding surfaces are 

 dried as far as possible, covered with antiseptic 

 vaseline [vaseline 50, powdered boric acid 5, iodo- 

 form 1], closely approximated throughout their 

 extent, i.e. both superficially and deeply, and 

 every effort made to secure contact. When coapta- 

 tion 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 layers, it may be 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 silk-worm gut. Lastly, the 

 surface is washed with sublimate solution, dried 

 with tampons of absorbent wool, and covered with 

 a film of iodoform collodion, or with a dressing of 

 surgical wool. 



When it is impossible to bring the surfaces of 



the wound perfectly together, or when there has 



-Irrigator Deen much loss of substance, provision must be 



for h hanSng US on made to P re vent the accumulation of discharges by 



wall. inserting one or more rubber drainage-tubes, a 



strand of plaited catgut ligatures, or a strip of 



gauze. Rubber drainage-tubes are generally employed. They 



should reach the depth of the wound, and as they tend to 



spring out, they should be fixed to the lips of the wound by 



a silk or other suture. Their presence allows antiseptic injections 



to be made into the bottom of the wound without touching 



the sutures. When the wound is redressed the tube must be 



Fig. 89. 



