Operation Wounds.—The object of the surgeon is to obtain primary union in all wounds which he necessarily inflicts during a cutting operation. This can only be effected by the most rigid asepsis, arrest of hemorrhage, and the bringing together in accurate apposition the edges of the wound, which is then to he shut out from the air by the application of dry sterile gauze. A recent method of securing accurate apposition in operation wounds is very popular. This consists in making a series of scratches parallel and about one inch apart across the line of the skin incision.
Perfect asepsis is only obtainable by a very close attention to numerous details, the omission of any one of which vitiates the result. The first step consists in a thorough cleansing of the skin, which should be freed from hairs by shaving. Soap and a hair-brush are to be freely used to remove all filth and dead epithelial cells with their accumulated microbes; the scrubbing must be performed, being the basis of all sterilising treatment. The cleansed surface is next swilled with Turpentine Oil or Ether to dissolve all sebaceous or fatty secretion, and strong Rectified Spirit is applied to remove the turpentine, after which the entire area is washed with a r to r.000 Bichloride of Mercury or Biniodide solution.
When immediate operation is not necessary, these steps are gone through on the previous night, and the part covered with a 2 per cent. Formalin Compress or a layer of gauze soaked in the mercurial solution. If Iodine or Picric Acid solution is to be used, the compress is omitted and the part covered with a layer of sterile lint. In the morning the operation field is painted over with the Iodine or Picric, a process which is repeated when the patient reaches the operation table.
Many surgeons now employ Iodine by painting over the entire area with the strong tincture a short time before operating, as practised first by Eiselsberg of Vienna. This is a very decided advance upon all former methods of sterilising the skin, but it does not do away with the necessary cleansing, scrubbing, turpentine and alcohol. When the skin is tender
a mixture of equal parts of the strong and weak tincture may be used, and it is desirable not to apply any moist lotion afterwards, as the drier the skin is kept the better in order to keep the mouths of the cutaneous glands sealed up during and after the operation. Sir Alexander Dempsey has informed the writer that he has observed the skin discoloured for a considerable depth, when the cutaneous section is examined by the naked eye, which proves that the solution penetrates the upper layers of the true skin.
The hands and forearms of the operator are to be submitted to the same cleansing process by soap and nail-brush, turpentine and alcohol, and finally by being thoroughly immersed in the mercurial solution. (Iodine is here obviously inadmissible owing to its staining powers.) At intervals during a prolonged operation the surgeon will require to immerse his hands in the mercurial solution to destroy any germs which have exuded from the cutaneous glands. Some operators rely upon frequent rinsing with Saline solution, but Watson Cheyne sounds a note of warning against the too rigid observance of maintaining perfect asepsis without the employment of antiseptic solutions, and he points out that sterilisation of towels and instruments should not be left entirely to heat. During a prolonged operation instruments, swabs, sponges, &c., though previously sterilised by heat, should be occasionally dropped into an antiseptic liquid instead of being rinsed or wrung out of Saline solution.
The area of the skin in the neighbourhood of the incision should be protected by sterilised towels, and it is hardly necessary to state that everything brought into contact with the wound should be in a perfectly aseptic condition. Most surgeons, especially in abdominal operations, envelop the hands in fine rubber gloves previously sterilised by boiling, or by powdering and placing them in the drum with dressings, coats, &c., to be sterilised by dry heat.