. Modern surgery, general and operative. ld betaken and if a projectile is lodgedit should be located. The scalpshould be shaved and operations are done underlocal anesthesia. The wound inthe scalp (including the pericran-ium) should be excised by ellipticalincisions. A large flap (with thegunshot wound within its margins)should be laid down to permit ofexploration. The old custom ofenlarging the original woundshouldbe abandoned. The explorationthrough a large opening is neces-sary. It enables the surgeon tosee a fracture. In 40 per cent, ofsupposed scalp wounds fractureexists
. Modern surgery, general and operative. ld betaken and if a projectile is lodgedit should be located. The scalpshould be shaved and operations are done underlocal anesthesia. The wound inthe scalp (including the pericran-ium) should be excised by ellipticalincisions. A large flap (with thegunshot wound within its margins)should be laid down to permit ofexploration. The old custom ofenlarging the original woundshouldbe abandoned. The explorationthrough a large opening is neces-sary. It enables the surgeon tosee a fracture. In 40 per cent, ofsupposed scalp wounds fractureexists. The excision of both thewound in the bone and the woundin the scalp is imperative. Extirpate completely both the scalp wound and thebone wound. Gushing removes the entire wound in the bone cutting completelyaround it. It prevents infection from pus organisms, gas bacilli, etc. Whenthe wound is not excised late infection is common. If extirpation of thewounds is delayed for three or four days it is of little use. Excision enables us to. Fig. 584.—The drain has been bent to the re-quired depth and fixed to the scalp by plaster. Twosutures placed about 3 inches from the wound formsa better method of fixing the drain. By placing thesutures at a distance from the wound the drain ismade very flexible and moves freely with the pulsat-ing brain without exerting injurious pressure (Hull,Surgery in War). Treatment of Wounds in War 895 dispense with drainage in many cases. Without excision prolonged drainageis always necessary. Brief drainage combats infection. Prolonged drainageopens the doors to infection. If drainage is prolonged until the hair grows abovethe skin, infection is inevitable. If a wound injures the dura and involves thebrain drainage is always necessary. A metal tube blocks up. A rubber tubeblocks up and, sooner or later, is forced out upon the dressings. Gauze damsup pus and thus aids in the development of meningitis or abscess. Drainagemay be made by rubber tissue.
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