WOUNDS 225 



explains shortly the position of the operation wound and 

 the structures involved, rendering further description un- 

 necessary here. 



The operation ended, the dressing follows. Upon this 

 depends very largely the ultimate recovery of the patient, 

 for it is only by careful attention and suitable dressings 

 that effectual repair of the injured structures may be 

 brought about. 



A light shoe is first tacked on to the foot, and those 

 portions of the horny sole that have been allowed to remain 

 dressed with Venice turpentine, tar, or other thickly- 

 adherent antiseptic. 



The exposed soft tissues are then dressed with pledgets 

 of tow* soaked in alcohol and carbolic acid. This dressing 

 must be allowed to remain in position, and is kept there by 

 means of a bandage, or the shoe with plates (Fig. 55) and a 

 bandage over it. No pressure is needed ; consequently, the 

 pledgets of tow must not be too thick. 



In the after-dressing of the wound careful attention must 

 be paid to the granulating surface. Where tending to be- 

 come too vigorous in growth it should be held in check by 

 suitable caustic dressings. At the same time it must be 

 remembered that the granulating process of repair is 

 always more rapid upon the plantar cushion and fleshy 

 sole than upon the bone, or upon tendinous or cartilaginous 

 structures. As a result of this we have a wound showing 

 various aspects of cicatrization. Healthy granulation may 

 be profuse in one spot, while in another it may be checked 

 either by a flow of synovia from the still open bursa, or 

 by fragments of bone or of tendon still acting as foreign 

 bodies in the wound. These latter may be readily detected 

 by their standing out as dark and uncovered spots in the 

 healthy granulation around, and should be at once removed. 



* When using tow in the form of a pad, it is well to remember that 

 many small balls of the material rolled lightly in the palm of the 

 hand and afterwards massed together are far better than one large pad 

 of the tow taken without this preparation. The irregularities of the 

 wound are better fitted, and the whole dressing easier remains in situ 

 (H. C. E.). 



15 



