METHODS OF UNITING WOUNDS. J 01 



VI METHODS OF UNITING WOUNDS. 



Five methods of wound healing are recognised, viz : (1) immediate 

 union or primary adhesion ; (2) first intention or plastic adhesion ; 

 (3) second intention or granulation ; (4) third intention or union of 

 two opposed granulating surfaces ; (5) healing under a scab. Healing 

 by primary adhesion seldom occurs except in small aseptic operation 

 wounds. Healing by first intention or by adhesive inflammation 

 occurs in aseptic incised wounds in which the edges have been main- 

 tained in apposition and free from irritation. Lacerated, contused, 

 punctured and open wounds heal by second intention, but owing 

 to infection, the process is usually accompanied by pus formation. 

 In healing under a scab, the protective may be formed of dried blood 

 or exudate, or furnished by antiseptic adhesives (collodion, tannoform, 

 iodoform and tannin), or by the carbonised tissues as in using the 

 actual cautery after amputation of the horse's tail. 



Healing by first intention with the formation of a mere linear 

 cicatrix is the surgeon's ideal, but can only be attained when the 

 margins of the wound are accurately united and held steadily in 

 position. Given these conditions, healing by plastic adhesion is 

 assured in an aseptic wound. Apposition is best effected by sutures, 

 i.e. by drawing together the edges of the wounds by stitches ; though 

 some wounds may be united by the use of adhesives like collodion, 

 wound gelatine (either alone or with the addition of oxide of zinc), 

 sticking-plaster, pitch plaster, or strips of fabric fastened to neigh- 

 bouring parts by glue. 



The wound is disinfected, the hair shaved from the neighbouring 

 parts, the skin dried, and slender strips of plaster applied at right 

 angles to the long axis of the wound. Once these firmly adhere, 

 the edges of the wound are pressed firmly together, the free ends 

 of the strips of plaster carried straight across with some tension, 

 and fastened on the opposite side. Another method is to fix strips 

 on either side alternately, and by drawing in opposite directions 

 on opposing pairs to bring together the lips of the wound. A third 

 method consists in fixing a somewhat broad strip of plaster along 

 each edge of the wound and uniting the strips by sewing. Degive 

 uses rubber bands to draw together the strips in place of sewing. 



In using collodion the edges of the wound are pressed together 

 with the fingers, the collodion applied thickly, and the wound held 

 until such time as the dressing has had time to dry. Strips of linen 

 may also be saturated with collodion, and applied rapidly across 

 the edges of the wound whilst the lips are pressed together. 



