The operating room and the patient; a manual of pre- and post-operative treatment . plint while he is up. This should be removedwhen he lies down. Some passive movements ma5 be cautiously attempted from time to time afterthe first three weeks; these may beincreased as time passes. To preventrefracture from an accidental fall,the patient may wear a check ap-paratus (Fig. 176). Amputations and Disarticulations.—The after-treabment of these casesdepends somewhat upon whether thewound is left open or is sutured, uponthe lesion necessitating the operation,and upon the technic employed. General Rule
The operating room and the patient; a manual of pre- and post-operative treatment . plint while he is up. This should be removedwhen he lies down. Some passive movements ma5 be cautiously attempted from time to time afterthe first three weeks; these may beincreased as time passes. To preventrefracture from an accidental fall,the patient may wear a check ap-paratus (Fig. 176). Amputations and Disarticulations.—The after-treabment of these casesdepends somewhat upon whether thewound is left open or is sutured, uponthe lesion necessitating the operation,and upon the technic employed. General Rules. Stay in Bed.—It is desirable to get these patients out of bed and in the sunlight as quickly as their general condition will permit. Usually four or five days rest in bed will be sufficient. The patient may then be lifted into a wheel chair if this wUl not interfere with the rest of the wound which must be kept quiet for ten days. Crutches after amputation upon the lower extremity may be used on the tenth day or as soon thereafter as wound healing is practically Fig. 176.—Brace for frac-ture of the patella. (Fowlers Surgery.) OPERATIONS UPON SPECIAL TISSUES 343 Care of the Wound.—The regular stump dressing is applied(p. 345) in all cases. The outer dressing is changed at the endof forty-eight hours or sooner if soiled. Sutures are removedon the tenth day. The tender cicatrix is then supported bynarrow strips of adhesive plaster. Drainage in cases treatedopenly has been sufficiently discussed. In cases sutured pri-marily it iS; as a rule, unnecessary to employ drainage, thespaces between the sutures being usually sufficient to allow ofthe escape of serum. Should oozing be expected, due to thegreat vascularity of the parts, it is well to provide for its escapeby placing a small drainage tube in each angle of the wound. Insuch cases a provisional suture is placed at the point of emer-gence of each drain to be tightened upon removal of the are rem
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