DRESSING OF OPERATION WOUNDS. 



85 



removed, disinfected, shortened if necessary, and replaced. Its 

 outlet should be level with the wound edges and not compressed in 

 any way. 



The seat of operation is protected by a " dressing " formed of 

 layers of surgical wadding or tow, suitably arranged and fixed in 

 position by bandages (see " Bandaging and Dressing "). Dressings 

 applied to the upper regions of a limb should either be com- 

 paratively loose or should extend to all the parts below, in order 

 to avoid interference with circulation and such consequences as 

 swelling and sloughing. 



The first dressing is exceedingly important. Very often it 

 determines the entire after- 

 course of the wound. It can 

 be left in place for a varying 

 time. If the patient's general 

 condition is good, and the fever 

 is slight, and if the dressing 

 remains dry, it need not be 

 renewed for twelve to fifteen 

 days in winter, and from eight 

 to ten days in summer. If, 

 during removal, the deep layers 

 of wadding adhere to the skin, 

 they should be moistened and 

 softened with a warm anti- 

 septic solution, or in the case 

 of the foot by placing the 

 extremity in a bucket con- 

 taining the liquid. The skin 

 should be carefully cleansed 

 with tampons of cotton wool. 



Where primary union has 

 occurred the wound is found cicatrised on removal of the first 

 dressing : if, however, it is only progressing favourably, nothing 

 more is needed than the application of a fresh dressing, the 

 same precautions being observed as on the first occasion. Care 

 must be taken to avoid disturbing the wound or moving the 

 lips ; drainage-tubes can be replaced after disinfection, fresh ones 

 of similar calibre but of shorter length can be substituted, or 

 drainage-tubes may altogether be discontinued. When the wound 

 is suppurating the sutures must be cut, the drainage-tubes removed, 

 and the whole cavity freely washed out, avoiding injury to granu- 



Fig. 90. — Portable irrigator. 



