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Dressing

Dressing material is a material used in operations and dressings for drying the surgical field, wounds , for tamponade and dressings. The dressing material should not change during sterilization, it is good to suck the discharge from the wound (to be hygroscopic), not to irritate the wound tissues. The main dressings - gauze (see), cotton wool (see), lignin (wood wool). Substitutes: moss, peat, sawdust (in gauze bags).

Gauze is prepared for operations and dressings in the form of napkins (8X8 cm, 50X10 cm, 50X30 cm). A piece of gauze is cut off from a piece of gauze, the edges of the edge are folded inward and the napkin is folded four times. Napkins are used in dry form or moistened in warm sterile isotonic sodium chloride solution to protect against drying out of the peritoneum, intestinal loops during laparotomy (see). At large chrevosechki often field operations are fenced off from the other parts of the abdominal cavity and reduce the drop-down intestinal loops with the help of large gauze napkins. Long tapes (40 cm) are sometimes sewn to the ends of large napkins so that the napkins are not forgotten in the wound.

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Long strips of gauze - tampons (width 5-10 cm, length 20-30 cm). The edges of the edges are folded inward and the tampons are folded first in length, then four times. Napkins for plugging according to the method of Mikulich are prepared as follows. In the center of a large gauze napkin reinforce a thick silk thread with a strong knot. The napkin is folded, sterilized and then, taking the center of the tampon with forceps, inject it into the wound in the form of a half-open umbrella; the cavity of the formed bag is performed with ordinary tampons, easily replaceable. Remove the tampon, pulling the string. Small tampons (10X10 cm) are used to dry the wound; they are rolled up in the form of a ball (envelope) so that individual crumbling threads could not get into the wound. Apply and martine balls, wrapped in gauze a ball of absorbent cotton. Clean wounds are covered with stickers that are made from strips of cotton wrapped in gauze, or the same size strips of gauze. They are strengthened with a cleavage or collodion bandage (see Desmurgy). Preparation of bandages - see. Screw.

Lignin - wood wool from the cellular elements of wood, well absorbs. It is placed on top of gauze and a small layer of cotton wool for wounds with copious pus. For dressings, substitutes are also included (see above). They are cleaned of impurities and sterilized in bags of gauze or better cotton fabric. Apply them over a gauze dressing to replace cotton wool.

Sterilization of dressings is carried out, as a rule, in autoclaves (see Sterilization in surgery ). Along with aseptic dressing apply antiseptic dressings, t. E. The gauze and cotton wool soaked in antiseptic solution (mercuric chloride, iodoform, malachite and brilliant green, furatsilin ) or antibiotics ( sintomitsina , biomycin ) to influence the microbial flora wounds or for better preservation of sterility of the material. For ligation of superficial wounds and abrasions, there is a plaster (see Desmurgy) and bactericidal paper impregnated with silver salts, which, after being wetted with sterile water, are applied to the wound. Dressings impregnated with hemostatic agents, as well as biological dressings - fibrin film and hemostatic sponge (see) - are used to stop bleeding.

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For first aid use ready sterile dressing bags with cotton-gauze pad, with bandage, with bandage and pin (see. Individual dressing bag), cotton-gauze pad, size 25X25 cm, 15X15 cm, 10X10 cm, napkins sterile in packs of 10 pieces 33x45 cm, 14x16 cm and sterile bandages. In the field, sterile ready-made dressings are used in the field for easy storage and transportation in the form of sets containing large and small dressings, bandages, cotton wool and scarves. On the packaging indicates the method of opening, which does not violate the sterility of the material. When using sterile dressings prepared at the factory, check that the shells of the bag are intact, and hence the sterility of the contents.

In order to save, you can use gauze again after washing, although its suction capacity is reduced. Only wipes, bandages and tampons used during aseptic surgery or dressing can be reused.

A used dressing is soaked in cold water or in a 0.5% solution of ammonia until the blood has dried, then it is washed, boiled, rinsed, dried, sterilized and used exclusively during dressings.

Dressing material is a material used in operations, dressings to protect the wound from secondary contamination, drying it, stopping bleeding and removing purulent discharge.

Requirements for the dressing material: good absorbability (hygroscopicity), capillarity, fast drying, the ability to sterilize, without compromising quality, elasticity, no irritating fabric properties.

Dressings include: gauze, cotton wool, lignin (alignin), jute (utah), granulose, canvas, moss, peat, lint, hemp, charcoal, glass wool, etc .; The most common gauze and cotton.

Gauze - cotton fabric of different varieties with a rare or thicker mesh. White gauze is highly hygroscopic. The surgical department receives the gauze in rolls. From it prepare napkins, tampons, bandages of various sizes, gauze balls. Gauze well absorbs blood from the wound, pus.

Napkins, gauze tampons are prepared so that the ends of the threads are bent inward, in order to avoid getting and leaving separate threads in the wound. Wipes and bandages after clean operations can be reused after appropriate treatment. If they are soaked in blood, they are immersed in the pelvis and poured with 0.5% aqueous solution of ammonia for 2-3 hours, then the ammonia is drained and re-poured with 0.5% soda solution for 30-40 minutes, then washed, boil in soapy water, rinse, dry and sterilize in the usual way. Bandages and wipes that are not soaked in blood can be washed and then sterilized. For reuse, the dressing material can only be used in dressings.

Cotton wool is made from cotton; applied either chemically purified, non-fat (hygroscopic) or non-fat, unbleached - gray or simple. Absorbent cotton has good absorbability and dries quickly, it increases the suction properties of the dressing, as it is applied to the wound over the gauze. Cotton wool is used only when applying warming compresses and as a bedding for gypsum bandages and splints.

From hygroscopic cotton wool cotton wool brushes are prepared for smearing the patient's skin with iodine and other medicines, as well as nail spaces on the hands of the participants in the operation.

Lignin (alignin), or wood wool, - thin pieces of wood of coniferous trees, mechanically and chemically treated; when folded, they form a loose, well-absorbing fabric. Lignin has exceptional hygroscopicity, absorbs better than gauze. It is not placed directly on the wound, but on top of the gauze and a small layer of cotton wool, as it crumbles easily and can clog the wound. Apply lignin in wounds with a large purulent discharge.

In the surgical wards, aseptic dressings made from gauze and cotton wool are mainly used. The antiseptic dressing impregnated with antiseptic substances (iodoform, xeroform, mercuric chloride, carbolic acid, etc.) is currently hardly used, since it is far from indifferent to tissues; it can cause irritation, cell death, and even general poisoning of the body; iodoform gauze is an exception, which is sometimes used to treat purulent wounds in bone tuberculosis. Some authors also recommend antiseptic dressings impregnated with a 1% aqueous solution of aniline dyes (crystal violet, malachite and brilliant green), or PBS preparations (furatsilin, bigoumal, syntomycin), or silver salts (in the form of porous antibacterial paper), or antibiotics for treatment purulent wounds.

In order to stop the bleeding locally, hemostatic preparations obtained from the blood and tissues of humans and animals are used (see. Blood, preparations). The hemostatic sponge, fibrin film, biological antiseptic tampon, dry thrombin, hemostatic synthetic gauze, etc. have found the greatest application.

A hemostatic sponge is prepared from human blood plasma with the addition of cerebral thromboplastin and calcium salts.

It is a dry porous mass, well absorbing moisture; absorbing blood, it turns into a thick film and covers the defect in the tissues. It is used in the form of powder or single massive pieces. The sponge remaining in the tissues is completely absorbed, so it can be used for bleeding during abdominal operations. Technique of application: the sponge is transferred with sterile tweezers from the opened bag to sterile dishes or sterile gauze. Apply a sponge on the bleeding surface, lightly press (for three minutes), after which the sponge, turning into a thick film, stops the bleeding.

Fibrin films obtained from human plasma are released on a cellophane lining in a sealed tube. Before use, the tube with the film is opened in compliance with the rules of asepsis. After opening the tube, the fibrin film is removed with sterile forceps, freed from cellophane, washed with an antiseptic solution (5% sodium sulfathiazole solution, 5% sodium sulfacyl solution, penicillin solution or rivanol solution) and applied to the wound surface (for example, a burn after pretreatment - removal blistering and antiseptic treatment). An antiseptic dressing is applied to the film for 3-6 days.

Biological antiseptic tampon (BAT) is an active hemostatic and at the same time antibacterial drug designed to stop bleeding during neurosurgical operations, operations in the nasal cavity, on the uterus, etc. It is prepared from plasma and blood serum with the addition of gelatin, hemostatic and antimicrobial agents . Dry thrombin is prepared from human blood plasma; apply (with the observance of asepsis) for capillary bleeding from wounds, nasal, dental bleeding. Sterile gauze balls are applied to the bleeding site, soaked in thrombin solution abundantly. After 5-10 minutes gauze balls are carefully removed, bleeding stops.

Hemostatic gauze ZOLIPK is obtained by the oxidation of cellulose (normal gauze) with nitrogen dioxide. Available in the form of sterile napkins 13x13 cm in hermetically sealed penicillin vials. Used as a hemostatic agent for bleeding from parenchymal organs, as well as for capillary and venous bleeding. The advantage of hemostatic gauze is that it is completely absorbed, without causing side effects, and stops the bleeding.