132 WOUND TREATMENT 



rest in a flexed position, if such position does not cause 

 gaping of the wound. Absolute rest is best attained by 

 means of suitable splints, or firm bandages in wounds 

 of sufficient importance to require it or make it advisable. 



The floor of a deep Ijaceration, as of the perineum, 

 becomes covered after several hours with a varnish-like 

 glazing of coagulated fibrin from the exuded serum. 

 Suturing at this stage wiU ofttimes give first-intention 

 union even better than primary suturing. 



If not closed, an open glazed wound becomes covered 

 in two or three days with a dirty grayish membrane, 

 which separates after a few days and is discharged with 

 the pus, leaving a base of bright red granulation tissue. 

 Granulation tissue is the vascular framework upon which 

 cicatricial tissue grows. When it reaches the level of the 

 skin, a transparent, delicate film appears around the 

 edges and extends gradually out toward the center of 

 the granulating surface, like ice freezing over a pond. 

 This film is, of course, new epithelium, though I have 

 seen nurses and doctors carefully wiping it away with 

 wet gauze or cotton in the blissful notion that it was 

 foreign material. 



New epithelial cells are , as readily destroyed by chem- 

 ical antiseptics as are pyogenic bacteria. There is not 

 only no excuse for washing a healing wound with germi- 

 cides, but positively a eontraindica,tion to such maltreat- 

 ment. Asepsis, not antisepsis, is the goal to strive for. 



Granulation tissue in large wounds or ulcers aids re 

 pair also by contracting and drawing the edges closer 

 together. This gives us a valuable hint for the use of 

 adhesive plaster about larger granulating surfaces. As 

 to strapping directly upon the granulations, personally 

 I have had only unpleasant results. 



A wound whose edges are not approximated may stiU 

 heal without suppuration if it be filled with aseptic blood 



