If the wound is not a perforating wound, but a deep wound, the tubes are planted deep into the cavity that may be formed. These tubes are always of sufficient number to thoroughly irrigate the broken surface.
Over the uninjured skin, about the wound, is placed thin strips of gauze which have been steeped in vaseline, the skin having been thoroughly washed before with soap and water.
To keep these tubes in place, a bandage wet with Dakin's solution is placed over them. The wound is flushed every two hours with Dakin's solution. The amount of solution used per wound, varies in proportion to the size of the wound from 500 c.c. per day up. Wounds are dressed daily.
The bacteriological observation is made by taking a smear from the most vicious part of the wound at intervals of two or three days. The number of bacteria on these smears is noted and counted per oil immersion field. A count of more than 75 bacteria per field is considered infinity. When there are less than 10 bacilli to the field, and not less than 5 to the field, three fields are counted. When less than 5, and not less than 7, five fields are counted. When less than one, from five to twenty fields will be counted.
A wound that retains a count of one bacillus to two fields or less for three observations, is considered bacteriologically clean, and suitable for operation. If the wound is a compound fracture, it is advisable to close the wound, converting it into a simple fracture.
If this can be done without exerting too great tension on the sutures.
If the wound is a flesh wound, and can be drawn together without too great tension, its closure is indicated.
[Illustration]
The important parts of the treatment consist in thorough irrigation, and careful bacteriological observation. The bacteriological observations are charted on charts similar to temperature charts.
Dakin's Solution.
(Sodium Hypochlorite at 0.50%)