The local treatment of wounds

Abstract

B Y the “Local Treatment of Wounds” is meant treatment as apphed directIy to tissues, the continuity of which has been severed. Genera1 treatment such as the administration of bIood, fluids, chIorides, foods, vaccines and antitoxins wiI1 not be discussed. The influence of disease states such as anemia and diabetes wiI1 purposeIy be omitted. Even with these limitations the subject is Iarge and must necessariIy be confined to the principIes of treatment without reference to specific Iocations of wounds. SpeciaI considerations enter into the treatment of wounds of the eye, brain, pIeura, heart, peritoneum, urinary bIadder, joints and other important structures which makes of each one a subject in itseIf. The principIes underIying the treatment of wounds are the same, however, regardIess of their extent or Iocation. Before studying the treatment of wounds it is proper to inquire into their methods of heaIing. How do wounds heaI? What agencies or factors faciIitate this process and which ones retard it? Most pathoIogists and surgeons speak of wounds as heaIing by first and second intention. The two processes are essentiaIIy the same. By first intention is meant the prompt heaIing of a wound with very IittIe inffammatory reaction, the reaction being so smaI1 that there is no redness and no grossIy appreciabIe sweIIing of the wound and no secretion from it other than cIear serum or norma bIood within the first few hours. HeaIing by second intention is the same process to which is added the phenomena of inflammation. Inffammation is due to some injury to the tissues and causes a deIay in the heaIing process. The amount of deIay depends upon the severity of the injury and the abihty of the body to overcome it.‘Once the irritant is removed by the inffammatory process heaIing rapidIy progresses. Since heaIing is due to an actua1 growth of ceIIs anything which prevents the approximation of tissues during the heaIing process and disturbs that process once it is started wiI1 deIay heaIing. To obtain prompt heaIing, or in other words heaIing by first intention, we must excIude from wounds any factor which prevents approximation and any injurious substance. Substances injurious to wounds may be divided into bacteriaI, mechanica1, physica1, and chemica1. The importance of excIuding bacteria from wounds is now generaIIy recognized and the various methods of excIusion wiI1 not be described. Attention is caIIed however to the recent work of Dandy and of MeIeney. Dandy emphasized the importance of adequate steriIizations of suppIies. He has proved that a constant minimum pressure of 20 pounds for at Ieast one hour is necessary to kiI1 bacteria by autocIaving. MeIeney found that members of the operating room personne1 sometimes carried streptococci in their noses and throats which Iead to serious postoperative infections. He reduced the incidence of such infections by covering the nose and mouth of every person entering the operating room. RoutineIy now when postoperative infections occur he makes cuItures of the noses and throats of the entire surgica1 staff to discover if carriers are present.