Iodol (Tetraido Pyrol) (Kalle).—A light grayish-brown powder, containing eighty-nine per cent iodid. Slightly soluble in water, soluble in alcohol and chloroform. Its action is very similar to iodoform, and has taken its place to a great extent, first, because it is odorless, and secondly, because any quantity used exerts no toxic effect (Wolfenden). It is dusted upon the wound. Its action is due to the liberation of iodin, which acts upon the albuminous elements, and the ozone set free oxidizes the products of decomposition. It has a slight escharotic effect, forming a thin crust over the surface to which it is applied, thus effectually remaining in constant contact with it. That it is quickly absorbed is shown by its presence in the saliva and the urine.
Orthoform (Methyl Ester of Meta-Amido-Para-Oxybenzoic Acid).—Nonpoisonous, white, odorless powder of moderate antiseptic power, and well suited for wounds involving mucous membranes. It has a decided anesthetic effect, lasting for several hours upon painful wound surfaces.
Iodoform (Formyl Iodid, Féréol).—A lemon-yellow crystalline powder of penetrating, saffronlike odor. Contains ninety-seven per cent iodin. Insoluble in water, but forms solution with alcohol, ether, chloroform, and the fixed volatile oils. Has a decided stimulating effect on wounds by preventing putrefaction and deodorization (Mikulicz). Its antiseptic value has been much discussed, but practically it has found favor with the majority of surgeons. According to research, iodoform is a powerful antiseptic, from the fact that the product of its decomposition in the presence of germ life renders the ptomains in a wound inert, thus preventing suppuration, or at least checking the absorption of such, which is often a serious matter in infected wounds. It is not sterile, and may contain ptomains which in themselves would produce pus, but as associated with the iodoform do not occasion it.
CHAPTER V
WOUND DRESSINGS
The dressing or treatment of wounds, considered herein, embodies particularly that practiced by the surgeon in the performance of plastic operations.
The elasticity of the skin is especially serviceable in bringing about desirable restorative results, but, owing to its extreme vascularity and the infrequent supply of venous valves, as in the face, there is considerable danger of infection, with rapidly spreading septic inflammation.
Sutured Wounds.—Before the wound is closed all hemorrhage must be arrested, either by catgut ligature, in exceptional cases, and by torsion or pressure, as generally practiced. Gauze sponges dipped into hot sterilized solution are most suitable for the latter purpose.
The edges of the wound must be coapted perfectly by cutaneous sutures of sterilized silk of suitable thickness. Formaldehyd catgut is often used because of its limited absorption. Ordinary catgut should not be employed, as its early absorption interferes with obtaining the proper union, and by becoming softened invites sepsis.
The wound, if small, may be powdered over with any of the antiseptic powders, such as aristol or iodol. It must be remembered that such powders form a hard crust with the serous oozing of wounds, which, by reason of pressure from the dressing applied over it, is very liable to separate the edges of the wound, thus increasing the width of the scar, a very important factor in facial surgery.