Drainage is provided where much oozing is anticipated, but ordinarily where strict asepsis has been maintained it is only necessary to control all hxmorrhage by ligature or torsion, and seal the wound up by suturing the margins in accurate apposition, covering the incision and surrounding skin with several layers of sterile gauze, upon the top of which sterilised Gamgee tissue or Wood Wool is laid. The edges of the wound should not be submitted to the action of any antiseptic; when the final toilet is performed the skin may be washed with the perchloride, iodine or picric solution after suturing and before applying the dry dressing. By the end of a week, the dressings being removed, healing by first intention will he found in a complete or advanced condition. (See also article on Operations, Treatment of.) Accidental Incised Wounds.—These, being usually infected before coming under the surgeon's notice, will require sterilisation. There are two ways in common use. One depends for its success on thorough scrubbing, first of the surroundings, and after these have been cleansed of the wound itself with soap and water, turpentine, ether or spirit, and an antiseptic, such as Biniodide of Mercury. The other method relies on the antiseptic action of weak Tincture of Iodine. if used on dry skin. Here no washing of any kind whatsoever is done, the wound being simply swabbed over two or three times with the iodine.
Much will depend upon the care with which the margins of the wound are brought together and maintained by sutures, as undue tension is certain to end in failure. Deep wounds will require separate buried sutures in each layer of tissue before the superficial stitches are inserted. When the gap is a wide one, it will be necessary to insert a couple of deep relaxation sutures at a distance from the lips of the wound in order to permit these to be kept in contact by the ordinary stitches. Very superficial wounds, when there is no gaping, may be treated by painting the skin with a layer of Collodion.
The question of providing drainage will he settled by the depth of the wound and the amount of sepsis to be feared; when in doubt it will he wise to insert a fine tube for 24 hours, especially in fat subjects.
The time for removal of the sutures will be determined upon inspection of the wound; in vascular parts, as about the face, when the wound has been thoroughly sterilised they may be removed on the third day to avoid marking; in other regions they may be left in for 7 days or more.
Punctured TVounds should always he regarded as serious unless the instrument causin,g the injury has been in a sterile condition, as, owing to the depth of the wound, it cannot be effectively cleansed. If in doubt, the best routine procedure is to enlarge the opening and convert the puncture into an incised wound, so that all clots, foreign bodies and septic organisms may be removed, and the surface sterilised, after which it will he advisable to provide efficient drainage, the tube being inserted down to the bottom of the wound.
Lacerated !rounds should be treated first by thorough cleansing, as in incised wounds, and then by removal of all tissue which has obviously been destroyed by the tearing, after which thorough irrigation of the entire breach of surface should be effected. As a rule sutures should not he inset tee] the gap may be filled in with a light packing of gauze, and after the appearance of granulations and the removal of any sloughs which have formed, secondary sutures may be employed.
Contused are to be treated on similar lines, and owing to the great danger of septic infection of the extensive extravasation of blood caused by the bruising, as much as possible of the clot should be removed, and free irrigation of the wound carried out by Saline solution: drainage must be provided and no sutures employed.
Post-morion and Poisoned Wounds should he promptly dealt with by applying a ligature or tourniquet on the proximal side of the injury as in Bier's method, or an exhausted suction cup may be placed directly over the wound, or it may be sucked by the patient's lips when small and accessible, care being taken to immediately rinse the mouth afterwards with any antiseptic liquid. Squeezing the wound should be resorted to without delay, and bleeding encouraged by any of the above means, and when these fail its lips should he freely extended by incising with a sharp scalpel, after which thorough irrigation with Carbolic, Boric, or Perchloride of Mercury solution should be carried out. Small wounds should be swabbed with pure Carbolic Acid or by a r in 25o Perchloride solution, and dressed with a warm Boric compress (see also under hydrophobia for the treatment of bites caused by rabid animals).
Should signs and symptoms of acute septic inflammation have super vened when the wound first comes under observation, it should be im mediately opened up, and thoroughly sterilised with pure Carbolic. Acid or strong Perchloride solution. A safe plan is to inject a few minims of a i in 5 solution of Carbolic Acid into the tissues around the wound, after which the injured limb should he continuously immersed in a bath of hot saturated Boric Acid solution.
Abscesses, as soon as the signs suggestive of suppuration appear, should be freely incised and drained, and early Vaccine treatment instituted, the best procedure being to immediately inject a polyvalent antistreptococcic vaccine or serum, whilst an autogenous culture is being prepared. In severe cases amputation may be necessary to save life.