LACERATED WOUND OF THE BUTTOCKS 495 



The wound is located on the hip behind the articulation, 

 on the level of the os innominatum or slightly below it. The 

 biceps rotator tibialis and the triceps abductor femoris are 

 the muscles usually invaded. In addition to a triangular 

 rent in the skin whose dimensions vary from three to six 

 inches on each side, the muscles are more or less torn. 

 Owing to the bluntness of the object inflicting the wound 

 there is seldom much bleeding. 



TREATMENT. — There are two courses to choose in the 

 treatment of this wound ; one is open wound treatment, and 

 the other is suturing and draining. The former is much the 

 preferable one when the patient cannot be conveyed to the 

 hospital ; on the other hand if nosocomial accommodations 

 are within reach, the latter should be selected. 



Open wound treatment should begin by a thorough me- 

 chanical disinfection in which the shreds and the dirt are 

 disposed of by trimming the surface. Then, after the bleed- 

 ing has ceased, the whole surface is painted with the follow- 

 ing solution: mercuric chloride four drams, hydrochloric 

 acid, two ounces, and alcohol twelve ounces, and then filled 

 up with as much boric acid as will pack into the recesses 

 and adhere to the prominent parts. The boric acid is re- 

 applied frequently during each day, and the cauterant solu- 

 tion once daily until a bed of rosy granulations has formed 

 beneath the eschar. Thereafter, mild astringents — white 

 lotion — will answer. 



The proper procedure against this wound, however, is 

 the. surgical method. The patient is confined on the table, 

 or, if very tractable, with the single sideline, The skin 

 around the wound is shaved about two inches from the edge. 

 Before shaving the cavity is packed with cotton to prevent 

 the shaved hairs from falling into it, and before the cotton 

 is removed the shaved surface is disinfected- with mercuric 

 chloride 1-500 and then given a good friction with alcohol. 

 The cotton is now removed and the cavity submitted to a 

 thorough trimming of all unviable elements — dirt and con- 

 spicuous protrusions that would obstruct the flow of secre- 

 tions toward the drainage orifice to be provided subse- 

 quently. When the bleeding has ceased the surface is 

 sprinkled with iodoform. 



SUTURING. — A row of button sutures or mattress su- 

 tures (Figs. 56-57) are first adjusted around the two sides 

 about one inch from the edges ; then these are drawn togeth- 

 er and approximated neatly with interrupted sutures. A 

 small orifice is provided inferiorly and superiorly for the 



