Plastic and cosmetic surgery

by Frederick Strange Kolle

Natural or sea sponges are now little used in surgery, owing to their peculiar cellular construction. They invite and readily retain spores and germs, are difficult to clean, and require almost constant attention to be at all safe.

Many methods for rendering these sponges aseptic have been proposed, but at best the life of such a sponge is short and hardly pays for the labor and time expended. The absorbing power of a sponge is, of course, its essential quality. For plastic operations sterilized absorbent cotton made into small balls answers every purpose. These puffs of cotton are covered with gauze to prevent the fraying out of the fibers. To further improve them, their centers may be made up of cellulose or wood fiber. When an absorbent cotton sponge is moistened and squeezed out it does not answer as well, since its absorbing qualities are much reduced; the addition of the other material overcomes this.

A much-used and inexpensive sponge having great absorbing power is made in the form of a small compress of sterilized gauze held together with one or two stitches of thread. All of the above sponges are sterilized with the needed dressings and are burned after use. When removed from the sterilizer they are placed in a suitable basin containing six per cent sterilized salt water. It is well to place the receptacle close by the assistant who is to sponge. An enameled iron basin rack, as shown in [Fig. 12], answers the purpose best.

Fig. 12.—Basins and Rack.

The soiled sponges are thrown into a lower empty basin or one placed at the operator’s feet. As they are removed from the solution they are squeezed as dry as possible and pressed upon, rather than wiped across, the operative field. It must be remembered that the surgeon’s work must not be hampered by slow or inefficient sponging, and that this procedure must be quick and timely. It is well for the assistant to become accustomed to the habit of the operator.

The best assistant is one who has acquired a methodical and regular manipulation, a result dependent upon constant individual association; such a one is practically invaluable for the skillful performance of plastic surgery. He becomes not only familiar with the one thing, but cultivates a ready knowledge of the arrest of hemorrhage by digital compression when hemostatic forceps would hinder the ease of work, besides cultivating a happy manner of holding retractors or spreading the edges of the incisions with the free hand. As in most of these operations hemorrhage cannot be controlled by the so-called bloodless method. The assistant must control the constant oozing by the gentle pressure of the sponge quickly applied at short intervals. When the sponges are squeezed out in salt solution, as hot as the hand will bear comfortably, capillary oozing is more readily overcome.

STERILIZATION OF DRESSINGS

All dressings to be used in covering wounds, post operatio, or otherwise, must be as scrupulously clean and free from infection as the hands and the instruments of the operator. This is done by means of sterilization by dry heat or steam under pressure. For all minor cases, small apparatuses only are needed. They are usually made of copper, often nickel-plated, and so constructed as to contain a lower perforated instrument tray and another, placed above it, for dressings. The two are fitted into an outer copper receptacle with snugly fitting cover. A folding stand is furnished upon which this arrangement is placed, and an alcohol lamp with asbestos wick furnishes the heating power. The lower tray is covered with water which, by boiling, fills the upper compartment with steam evenly distributed and with sufficient pressure to accomplish sterilization in from thirty to sixty minutes. Metal hooks are provided with which the trays can be removed. A complete and compact outfit, as designed by Willy Meyer, is shown in [Fig. 13].

In the above sterilizer, or in those of similar type, there is naturally more or less saturation of the dressings and the possibility, in the event of the entire conversion of the water contained therein into steam, of injuring the instruments by excessive heat. To overcome this defect the Wallace sterilizer may be advantageously employed.