. Manual of operative surgery. skin further away is covered by stiff zinc oxide gauze dressings are applied through which the Dakin tubes emerge instillations of Dakins solution are made in quantity equal to about 300 OPERATIONS ON THE CHEST half the capacity of the cavity. Every 24 hours the dressings and tubes arechanged. When sterility is attained (smears and cultures from cavity) andmaintained for several days treatment is discontinued, the wound heals if leftalone and permanent recovery ensues. If the cavity has not become trulysterile the wound will reopen. In a
. Manual of operative surgery. skin further away is covered by stiff zinc oxide gauze dressings are applied through which the Dakin tubes emerge instillations of Dakins solution are made in quantity equal to about 300 OPERATIONS ON THE CHEST half the capacity of the cavity. Every 24 hours the dressings and tubes arechanged. When sterility is attained (smears and cultures from cavity) andmaintained for several days treatment is discontinued, the wound heals if leftalone and permanent recovery ensues. If the cavity has not become trulysterile the wound will reopen. In a few cases of healed empyema Moschowitz notes a very definite closedpneumothorax which disappeared after about a month by expansion of the lung. The cases which, according to Moschowitz cannot be remedied by longcontinued Carrel-Dakin teratment are: (i) Cases complicated by large pleuro-pulmonary fistulas. (2) Cases with retained foreign bodies, (3) cases with sidepockets or lateral branch sinuses (4) cases with necrotic Fig. 420.—{Report U. S. Empyema Commission.) Thoracotomy with resection of a segment of rib is usually much preferableto simple intercostal incision. In the latter the space is limited, finger explora-tion is difficult or impossible, and when the tube is introduced, it is very liableto be pinched between the ribs and rendered useless. Removal of a segment ofone or more ribs does no permanent harm and the operation is exceedingly of a segment of rib is rarely required in children and as rarely should itbe omitted in adults. In operating on non-localized empyema the incision maybe made over the sixth or seventh rib in the mid-axillary line, or over the ninthrib just external to the angle of the scapula, which is the best position. Incases of localized empyema the opening must of course be made over the encap-sulated pus. When incision is made in the mid-axillary line, the patient must bebrought to the edge of the table over which the affect
Size: 1481px × 1687px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1920, bookpublisherphila, bookyear1921
