Fig. 23. Fig. 24.
Angular Plaster Sutures.
The inner edges of the plasters are raised slightly, and interrupted sutures are inserted through them instead of the skin (see [Fig. 21]). They are then tied as shown in [Fig. 22]. In angular incisions the plasters are cut as desired to insure perfect coaptation, as in [Figs. 23 and 24]. The advantages of this method, besides those already mentioned, are that the wound is always open for inspection and permits of free drainage. If thought best, a small strip of iodoform gauze may be placed over the threads or even under them, if there is little tension.
Since the introduction of the aseptic Z. O. (Lilienthal) strips, the above method may be discarded as unnecessary and requiring too much time for their application. Strips of the antiseptic plaster are placed across the wound at right angles, or, if the surface be a curved one, obliquely to the wound. The plasters are furnished in strips of the width desired, packed in two germ-proof envelopes. They are extremely adhesive to dry surfaces. Besides being aseptic, they are slightly antiseptic and nonirritating. The strips are placed in position, leaving an open space between them while the assistant brings the edges of the wound into position.
Where there is tension of the parts this method is not to be employed. The wound may be dusted as when sutured and dressed in the same manner. The plasters are removed about the sixth day by drawing the ends of the strips toward the wound. Their second application is unnecessary, regular dressings being substituted.
From the above it must not be inferred that all plastic wounds are amenable to the above methods, because many require specific treatment, as later described.
Granulation.—Wounds left open for granulation should be dusted over with some stimulating antiseptic powder, such as aristol or boric acid, and then covered with iodoform or borated gauze. The granulating surface must be gently washed with a mild solution of peroxid.
Prolific hypertrophic granulations, that jut out over the surface, are touched with a lunar caustic point, avoiding the epithelial edge of the wound, where it causes considerable pain. Pale and loose granular points should be scraped away with the sharp spoon curette to hasten better growth.
If the skin edges are thickened and curled upon themselves, it may be best to curette or to reduce them by cauterization, so stimulating epitheliar spreading. Sterile gauze is then loosely laid upon the surface, backed with a highly absorbing material, such at charpie cotton (Burns), wood wool, and poplar sawdust, retained in gauze bags (Porter). The absorbing layer should be light and pervious to the air, to facilitate not only free absorption, but ready evaporation of the secretions.
Changing Dressings.—All dressings must be absolutely sterile and all precautions, as primarily carried out, must be followed in changing them.