In chiropodial practice, however, the degree of bleeding determines the method of treatment, and, though the extreme may fall short of actual danger, it still behooves the operator to control it absolutely before dismissing his patient.
Easily Controlled Bleeding. The degree of bleeding or slight oozing, as it should be termed, incident to skiving a calloused surface, is well controlled with styptics.
In employing these substances it should be borne in mind that they are not usually antiseptic but, on the contrary, may harbor organisms which may be transferred to the wound and cause infection. The subsulphate of iron, commonly employed in the form of Monsel’s solution, is usually employed because of its efficiency as a styptic, and because of the fact that it is less irritating than others. It, however, is not antiseptic and should be kept sterile and uncontaminated by dropping it upon the wound directly from the bottle, rather than by dipping the cotton-wound applicator into it, as is so frequently done. Even this does not prevent an originally sterile bottle of solution from becoming contaminated, exposure to the air, when the stopper is removed, admitting many bacteria each time.
A superior styptic has been supplied in the form of dry subsulphate of iron fused to small sticks of wood. These are efficient because of their cleanliness, each being used but once and at no appreciable expense.
It is needless to say that the dressing of even so slight a wound should prevent the admission of infection to the thousands of portals of infection which are present. A bandage is not indicated nor justifiable, and the cotton collodion cocoon suffices.
Persistent Bleeding. When bleeding occurs which does not yield to the effects of a styptic because of its constant washing away when applied, it becomes necessary to apply pressure to the wound. Frequently a wad of cotton or gauze, pressed firmly upon the bleeding area, will almost stop the bleeding in a few minutes, after which it becomes possible to apply the styptic. Should this, however, be found impossible and the bleeding resume when the pressure is released, clotting in the vessel can only be expected by the agency of either ligation of the tissue or any individual vessel or more commonly by tight bandaging. The latter procedure usually accomplishes the control of the hemorrhage incident to a deep dissection for papilloma or verucca.
A pad of several thicknesses of sterile gauze is placed upon the wound and held in place by a few turns of narrow bandage, applied quite tightly. Though blood may be seen to “spot” through this dressing, it should occasion no alarm unless the hemorrhage has been clearly either venous or arterial. Under such circumstances the spurting, either constant or intermittent, will give immediate evidence of its character. Active hemorrhage of this nature may yield to tight bandaging, but ligation of the vessel should be done.
Venous or Arterial Bleeding requiring ligation may be easily dealt with, and every chiropodist should be equipped with a small artery clamp with which to grasp the tissues; he should also be provided with sterile catgut, sizes 0 or 00, with which to ligate a bleeding vessel.
Antiseptic Precautions. In dealing with hemorrhage of even the slightest degree, it should be remembered that portals of entrance for bacteria upon the feet require every antiseptic precaution, both as to the treatment of the wound, and as to the instruments and dressings which come in contact with it.
For open wounds the U. S. P. tincture of iodin, diluted in water to one-half strength, is antiseptic and not extremely irritating.