Gauze Strip Research Articles

Ten-year report on the treatment of facial paralysis by tantalum gauze suspension of facial musculature

My experience dictates that tantalum wire suspension technic does possess certain distinct advantages, some of which will bear elaboration. (Figs. 4 and 5.) This operation provides a relatively simple means for counterbalancing adequately the facial muscle pull of the unparalyzed side to a fine degree, not only by varying the tension placed upon the requisite number of implanted tantalum wires but also by varying the position and size of the tantalum gauze plaques to be buried. It is a definite advantage to be able to provide further correction of recurrent deformity, due to subsequent relaxation at a later date, by merely tightening these tantalum wires through a small incision under local anesthesia in the hairline at their point of attachment to the saddles placed in the temporal fascia. The ability to perform all manipulation under local anesthesia, yet without causing the patient discomfort, has simplicity to recommend it, to which may be added avoidance of the dangers of postoperative pulmonary complications inherent in any general anesthesia. Certainly early postoperative ambulation and the ability to talk and eat soon after surgery, made possible by this method, are factors that recommend themselves to the patients. From a purely mechanical standpoint the use of tantalum wire has the following advantages: it produces no foreign body reaction, it is easier to work with than fascia, wires of any desired strength may be employed with only a slight increase in size; and the position and condition of these supporting wires may be determined easily by an x-ray of the patient's face. Several disadvantages of the wire suspension technic require mention. Obviously, the suspension of paralyzed muscles cannot produce a result comparable to that produced by a repair of the facial nerve which adequately reinnervates the paralyzed facial musculature; for although marked facial deformity has been removed, normal facial motion and expression are impossible. Caution must be exercised that neither the tantalum wires nor wire gauze are placed so close to the skin or mucous membrane that motion or irritation might cause them to be extruded. Care must also be taken that the pull of the tantalum wire supporting the facial musculature is well distributed by the utilization of segments of tantalum gauze. The necessity for a straight course for the supporting tantalum wires is of equal importance in the prevention of this complication. Suspension of the paralyzed muscles alone is often but one of several plastic procedures which may be required to produce the optimum cosmetic result. An associated face lift, as well as other plastic efforts, may be helpful as the individual case demands. Despite the limitations of tantalum wire suspension of facial paralyses, it is believed to be an operation which has a place in the treatment of irreparable damage as a result of partial or complete destruction of the facial nerve or inadequate innervation following facial nerve anastomoses. The use of tantalum gauze saddles and tantalum wire would also seem to be of value as an adjunct to primary and delayed facial nerve anastomoses in the prevention of stretching of the denervated facial muscles while regeneration is occurring. The mere insertion of tantalum gauze in the lips and cheeks offers sufficient support in many cases, making it unnecessary to run supporting wires to the temporal fascia. The passing of the tantalum gauze strips over the entire upper and lower lips is beneficial because it moderates the action on the normal side and supports the inactivated side, thereby bringing the two sides into better symmetry in action. This technic is favored because of the fact that there is now a choice of heavy or light wire, braided or solid wire, large or small elements, 50 or 100 mesh gauze of any design, all easily manipulated to fit each individual instance. Tantalum monofilament wire has been used in many cases for skin closure with very good results. The best closure is made with a regular double twist, as in the surgeon's knot, cutting both ends before the locking knot is placed on top. The ends of the suture lie flat on the surface and support the skin edges perfectly. Other beneficial uses for this material have been found in the eradication of frowns, wrinkles, sagging or relaxed skin, raising lower eyelids for correction of the palpebral fissure or supporting an upper lid to correct ptosis. In no case in my experience has it been necessary to remove the tantalum, nor has there been a tissue reaction or pain.

Local treatment of burns caused by molten tar; experimental study.

AT A RECENT surgical conference at the Edward J. Meyer Memorial Hospital, the question of how best to treat patients burned by molten tar was raised. Two answers were given to this question: One group maintained that the tar should be removed from the burn site; the other group held that the tar should not be touched, that it would slough off by itself with the underlying damaged tissue without lengthening the healing process or interfering with it. We used in this experiment a modification of the treatment outlined by Allen and Koch (1943), who suggested sterile petrolatum gauze strips, gauze fluffs, and pressure over the burn site supplied by an elastic roller bandage. This method eliminated dead spaces and prevented the loss of much plasma fluid. In our procedure we used, in addition to the pressure bandages, thick plaster casts as suggested by Levenson and Lund (1943). However, our

Failures with tantalum gauze in ventral hernia repair.

DURING the last seven years 139 cases of large ventral hernias with poor tissues have been operated upon using tantalum gauze in the repair. In approximately half these cases the edges of the defect could not be approximated. In these cases, flaps of the sac, reinforced with whatever scar tissue was present, were first overlapped to close the defect, and then the entire area was covered with tantalum gauze. In the other half of the cases, in which the fascial edges of the defect could be approximated, tantalum gauze was used to reinforce the suture line, either because of the weakness of the surrounding fascia or because of the tension under which the edges were approximated. In the early cases only a small strip of tantalum gauze was used to reinforce such suture lines. In five of these cases there were so-called false recurrences; that is, a hernia occurred at

A modified spinning-band column for low pressure fractionation

A spinning band fractionating column is described for operation at pressures down to 0.5 mm. of mercury. A study has been made of various designs of rotor. One type consisting of flat blades of stainless steel interspaced with bearings at regular intervals, which centered it in the column, gave an H.E.T.P. of 2.07 cm. at atmospheric pressure. At low pressures (0.5 mm.) its efficiency was found to be small, and a more suitable rotor has been developed in which strips of stainless steel gauze are attached to the blades. These wipe the walls of the column and provide an even film of reflux. Sharp separations of fatty, acid methyl esters, fatty alcohols, and acetates have been made, using this rotor at pressures of 0.5–2.0 mm. On account of the low pressure drop (0.4 mm. mercury) it is possible to fractionate compounds with 30 or 32 carbon atoms without decomposition.

A modified spinning band column for low pressure fractionation

SummaryA spinning band fractionating column is described for operation at pressures down to 0.5 mm. of mercury. A study has been made of various designs of rotor. One type consisting of flat blades of stainless steel interspaced with bearings at regular intervals, which centered it in the column, gave an H.E.T.P. of 2.07 cm. at atmospheric pressure. At low pressures (0.5 mm.) its efficiency was found to be small, and a more suitable rotor has been developed in which strips of stainless steel gauze are attached to the blades. These wipe the walls of the column and provide an even film of reflux. Sharp separations of fatty, acid methyl esters, fatty alcohols, and acetates have been made, using this rotor at pressures of 0.5–2.0 mm. On account of the low pressure drop (0.4 mm. mercury) it is possible to fractionate compounds with 30 or 32 carbon atoms without decomposition.

Treatment of antral cancer by combined surgery and radium therapy.

The purpose of this presentation is to detail steps of a method of treatment of cancer of the maxillary antrum by a combination of surgery and radium. The principles underlying the combined approach were outlined by Quick in 1930 (4). Extensive surveys of antral cancer in all its aspects have been published by Öhngren (3) and Windeyer (8). Surgical treatment alone has produced survivals of five years and more. The failures of surgery have been due to the site and nature of the disease. Complete extirpation of the involved maxilla is technically difficult. By the time the patient presents himself for treatment, the disease has usually infiltrated beyond the confines of the maxilla and a block resection is impossible. Irradiation alone has also produced survivals of five years or more. The failures of radiotherapy have been due to the difficulty of identifying the extent of involvement by physical examination and roentgenograms. Unless the disease can be accurately localized, unsuspected marginal extensions to the pterygoid fossa, the ethmoid air cells, or the floor of the orbit will receive less than a cancerocidal dose. Surgical exploration permits a more accurate determination of the extent of the disease. The surgical pathologist should be present in the operating room so that sites of local extension can be identified by frozen sections. The radiotherapist should be present so that he may gain exact knowledge of the condition he will be called upon to treat. With these points in mind, the steps in our procedure are now outlined. Surgery Preparation for operation includes a general survey of the patient with particular reference to distant metastases and evaluation of respiratory, cardiac, and kidney function. Examination of the chest by x-rays, an electrocardiogram, blood urea nitrogen and blood sugar determinations, a complete blood count, and urinalysis are secured. Corrective and protective medicines are ordered as indicated. Locally, much reliance is placed on the benefits of mouth and nasal irrigations and power sprays. Intramuscular administration of penicillin is started twenty-four hours before operation. The anesthesia is intravenous pentothal, supplemented by nitrous oxide and oxygen by way of an endotracheal tube passed through the opposite nostril. Passage through the mouth would interfere with the surgical manipulations. The pharynx is packed with a continuous strip of moist 3-inch gauze. When local anatomy prevents the use of the nasal passage, a preliminary tracheotomy under local anesthesia is carried out and the gas is introduced after the method of Schweizer (6). A tracheotomy is done in the very old and the very frail, preferably at the completion of surgery, to ensure an adequate airway during recovery from anesthesia and the ensuing few days. The external carotid artery is ligated in continuity on the side of surgery only when as near total resection of the maxilla as practicable is planned.

AN IMPROVED PACKING FOR SEPTUM RESECTIONS PERMITTING NASAL RESPIRATION

Working on the major premise that it is preferable to pack the nasal passages following resection of the septum in order to acquire more perfect approximation of the flaps of mucous membrane and to avoid the formation of a hematoma, the problem presents itself as to the proper type of packing to be employed. Diagram of an improved method of nasal packing, showing: a , the left naris; b , the Penrose tube; c , the gauze packing within the tube; d , the rubber catheter, and e , the heavy black silk thread. The one most commonly used in the past consisted of gauze strips lubricated with petrolatum, but this was found to abrade the delicate mucous membrane of the septum, and removal tore the newly formed adhesions and caused fresh bleeding. To obviate this difficulty, Sewall 1 described a modification of the method of packing with gauze. There was first inserted a

A METHOD OF NASAL PACKING FOLLOWING SUBMUCOUS RESECTION OF THE SEPTUM WHICH ALLOWS FREE NASAL RESPIRATION

The uncomfortableness and annoyance to the patient of having his nasal respiration completely obstructed by packing the nasal fossae, together with the dangers of secondary otitis media and sinusitis because of the nasal obstruction, are so well known to rhinologists that I need not elaborate on them. There are two methods in use for the after-treatment of the nasal septum following submucous resections, namely, one that provides for the packing of the nasal fossae with petrolatum gauze strip and another that omits the packing. The rhinologists who omit the packing do so because of the annoyance to the patient which the blocking of the nasal respiration causes, such as parched mouth from enforced oral respiration, pain in the ears on deglutition and difficulty in swallowing, and also because of the dangers of setting up an infection of the middle ear or of the sinus. On the other hand, others employ

Modification of Tear Sac Operations

<h2>Abstract</h2> The author's modification is designed to prevent hemorrhage during or after operation, and to promote primary healing. After removal of the sac and trephining, a folded strip of gauze is inserted in the trephined opening, by way of which it is afterward pulled on out through the nose with a pair of nasal forceps. A little of the gauze pack is withdrawn daily through the nose and cut off. The modification may be applied to every type of external dacryocystorhinostomy.

Determination of shadowless foreign bodies by X-ray examination. M. Sgabtzer (Zentr. f. Chir., 1928, No. 31)

The author proposes to fill wound cavities resp. fistulous passages with contrast masses, and foreign bodies (drainage tubes, gauze strips) that do not give shadows become visible during fluoroscopy.

Easy Method for Making Surface Casts to Hold Radium Tubes in Position

Through the kindness of Mr. Robert M. Kerr, of the Detroit Dental Manufacturing Company, Detroit, I have secured powdered molding compound which I incorporate in gauze strips (exactly as one would do with plaster-of-Paris), heat slightly over a hot plate, and mold to parts. The number of strips used depends upon the thickness desired, or, rather, the distance the radium tube is to be held away from the surface of the lesion or from the skin surface. If, however, the distance is more than one-quarter of an inch, I usually build up the casts at the point or points where the radium tube is to be placed; otherwise, it would prove cumbersome and heavy. This makes a light, strong cast, serves to hold radium tubes in exact position, particularly over irregular surfaces, and does away with the use of adhesive plaster over the seat of radiation. It has an advantage over ordinary molding compound in that it becomes hard quicker, will not stick to hairy parts, is not brittle, and when radium tubes are to be moved to different locations, these locations may be plainly marked on the cast and the tube moved without much difficulty. This method cannot, however, be used in mouth work.

A SLIGHT IMPROVEMENT IN THE TECHNIC OF INTRAUTERINE PACKING

It occasionally becomes necessary during the course of an obstetric or surgical practice to pack the uterine cavity. It also occasionally occurs that more than one length of packing gauze is needed to fill the cavity. Unless difficulty is to be experienced in removing the gauze, it is essential that each successive strip of gauze be united firmly to the one that precedes it. In the past, the general practice has been to tie the ends of the strips together by means of the square knot. It has happened that, following the packing and after the physiologic contraction of the cervix, the large bulk of the knotted gauze so formed offers considerable resistance to easy removal. The difficulty so encountered has been so severe as to make necessary a general anesthetic and a minor operative procedure to secure adequate room for the removal of the gauze knot. It was to overcome this difficulty that the procedure described here was devised.

PAROTITIS FOLLOWING INDUCED ABORTION IN A CASE OF PERNICIOUS VOMITING IN PREGNANCY

<h3>REPORT OF CASE</h3> Some time ago I was called into the country by Dr. Sharpe, in consultation, to see Mrs. X., a primipara, aged 23, who was then in her thirteenth week of pregnancy. Vomiting had begun on the eightieth day following the beginning of her last menstruation, and had become progressively worse until, at this time, it had reached the pernicious stage. The patient was much reduced and exhausted, but looked fairly well, and it was arranged that, should the remedies then suggested prove inadequate, interruption of the pregnancy must be undertaken without delay. Three days later, I dilated and emptied the uterus, placing a strip of iodoform gauze in the cavity and packing the vagina lightly with the same material. The following day the patient became nervous and disturbed, and these symptoms continued during the greater part of her illness, the delirium at times becoming boisterous and agitated.

A SIMPLE FACE MASK FOR USE BY CONTAGIOUS DISEASE ATTENDANTS

Modern scientific investigation has definitely established that the most frequent mode of transmission of infectious diseases is through droplet infection from the oral and nasal passages of the infected persons or unrecognized carriers of the infectious organisms. A recognition of this fact has caused the adoption at the base hospital, Camp Jackson, S. C., particularly by the physicians and other attendants of the cerebrospinal meningitis patients, of various forms of protective face masks. The one most commonly used is a gauze strip, made either of several layers of gauze bandage or more frequently of a gauze dressing roll, which covers the nose and mouth and is held in place at the occiput by a pin or a knot. This method entails the use of large quantities of gauze, and has proved generally unsatisfactory since it is uncomfortable, rarely remains in position, and causes fogginess of the eyeglasses. In recognition of

THE USE OF KEPHALIN TO HASTEN COAGULATION AND HEMOSTASIS AFTER SURGICAL OPERATIONS

The need of hemostatic gauze to be used where packing is now necessary in deep seated operations, such as perineal prostatectomies, in which bleeding occurs within the prostatic capsule from which large hypertrophied lobes have been enucleated, has long been recognized at this clinic. This hidden intracapsular bleeding is often considerable, and many strips of iodoform gauze tightly packed within the prostatic capsule have often been necessary, and are even then not entirely successful. Accordingly I have experimented with a gauze impregnated with kephalin, which was shown by Prof. William H. Howell to be the best clot forming substance. Following his methods I have made kephalin from the brains of hogs.1 The gauze is prepared as follows: The kephalin is dissolved in an excess of ether, about a 5 per cent. solution being made, and this concentrated kephalin solution is poured over gauze strips 6 feet long and 6

THE OPERATIVE TREATMENT OF BRAIN ABSCESS OF OTITIC ORIGIN

In dealing with the subject assigned to me in this symposium I shall detail the methods used by me in operating on and treating brain abscess complicating purulent middle-ear disease. As most of the abscesses the otologist sees occur after a mastoid or middle-ear operation has been done, this type will be discussed first. When a brain abscess is suspected following one or both of the above conditions and we find a stalk—"the pathway of infection"—leading from the tympanic cavity, aditus or roof of the mastoid antrum, it becomes a comparatively easy task to localize the pus collection by tracing the so-called stalk up to the abscess cavity, by director, knife or long narrow forceps; and when the pus is encountered, enlarging the original pathway of infection by cutting down on it from its dural entrance to the abscess cavity and wiping the cavity gently with sterile strips of gauze

Treatment of Burns.

Denver, Oct. 24, 1907. To the Editor: —In reading the article inThe Journal, September 7, page 863, on Treatment of Burns, my attention was called to the number of picric acid formulas recommended. I was also reminded of my own personal experience with the use of this compound after a severe bromin burn and the excruciating pain it caused me to suffer. After several dressings of picric acid solution on gauze strips, with as many periods of torture thereby induced, I decided to use some agent which was both antiseptic and anesthetic. Carbolic acid was, of course, one of the first to be thought of, but discarded because of its tendency to produce gangrene. It was then that liquor cresolis comp. was tried with the most gratifying results. Since then, some twelve years past, I have had many occasions to employ it, and whether the burn was due to

Tampon for Nose and Nasopharynx.

Minneapolis, April 18, 1905. <h3>To the Editor:</h3> —InThe Journal, April 1, page 1073, you abstract G. Lennhoff's description of a tampon for nose and nasopharynx, a long narrow strip of gauze tied at one end with a strong thread which is passed through several folds of the gauze, the string to be held by an assistant while the operator packs the gauze into the nose to the required extent. Permit me to make an addition to the technic, which makes the tampon the best possible. I have used such a tampon, which I devised five years ago, as an improvement on Ingals' many string tampon, with great satisfaction. The one difficulty is that of packing the gauze along the thread without entanglements. The best "assistant" is a tube, through which the string is passed, which serves to carry the tied end of gauze to the nasopharynx, and over which