CONTUSED WOUNDS. 135 
mate, carbolic acid, creolin, chloride of zinc, or permanganate of 
potassium ; their edges must be trimmed smooth, by cutting off all parts 
‘too much bruised and even a little more, and they must be joined in 
‘places by sutures closed or far apart, with or without drainage, as the 
case may be. Little attention needs to be paid to the hemorrhage, 
-even when arterioles or veinlets are lacerated; the crushing of the ex- 
ternal coat and the retraction of the two others insure hemostasis. 
‘When vessels of larger caliber are opened or divided, one must guard 
-against the possibility of a secondary hemorrhage and apply to them 
‘catgut ligatures. According to the region where the wound exists, 
this must afterwards be covered with an antiseptic dressing or with a 
‘coat of vaseline, also antiseptic. Ifthe wound gapes widely on account 
-of the retraction of the tissues on the border, is without great loss of 
‘substance and does not threaten gangrene, sutures may also be useful ; 
they bring the edges together, maintain them in proper position, make 
the space to be filled smaller, and cicatrix is limited, so that recov- 
ery is morerapid. But when the loss of substance is considerable, 
none of the previous means is to be applied—no sutures, no drainage ; 
other methods must be used. Wounds with gangrenous strips require 
-washings, baths, powders,—all of an antiseptic nature,—or continued 
irrigation. 
Very severe contused wounds, whose edges are bruised, crushed, 
loose, or hollowed by anfractuosities, must be treated open, with or 
‘without dressing, according to the region where they exist. After 
proper cleaning by cutting, with bistoury or scissors, the disorganized 
tissues, which are doomed to gangrene, should be disinfected with 
antiseptic washings ; in some cases, free incisions and counter-openings 
should be made, to prevent the stagnation of the pus in the irregular 
and undermined structures. In some regions where the involved 
muscles are covered with an aponeurosis, the tumefied muscular tissue 
may protrude through the solution of continuity of the aponeurosis ; it 
is then advantageous to incise the latter. Sub-aponeurosis phlegmons 
should be punctured at once, drairied and irrigated with antiseptic 
liquids. Contused wounds with bony lesions (face, withers, hip) 
‘require, ordinarily, a long time to cicatrize, and are often accompanied 
with necrosis or other secondary affections. (See Vecrosis.) 
Of all traumatic lesions, these are the most dangerous, as regards 
infectious complications. Therefore, it is emphatically commanded to 
telieve them of whatever foreign substances they may contain, and to 
purify them of all contamination they may have received. Irrigation. 
‘can never be too abundant, if the wound is irregular, anfractuous, un- 
dermined, or if the tissues have been soiled with hairs, manure, gravel, 
earth or dust. When the wounded part allows it, when, for instance, 
the injury is below the knee or the hock, it should be soaked for twenty 
