Desmurgy is a doctrine of bandages. It’s an unbiased part of basic surgical procedure. It’s the instructing of making use of bandages with the aim of therapy of accidents and a few illnesses. The time period “desmurgy” means a department of sensible surgical procedure which research the making use of bandages. It contains two ideas:
The bandaging materials, which is utilized on to the wound (dry, damp, ointment bandages).
The exterior a part of a bandage, which is utilized for the fixingof the bandaging materials on the wound.
A bandage in a wider understanding means a fancy of brokers utilized with the aim of safety of wounds or pathological cells from the affect of the atmosphere for a roughly longacting time period.
In a slender sense, a bandage means a fabric (bandage, plaster, and so on.), which is utilized on a wound for fixing the bandage materials with medical brokers. Lastly, the time period “bandaging” means a technique of making use of or altering medical bandages with its fixation.
The start of utilizing bandages dates from the traditional instances. Hippocrates wrote in regards to the utility of dry bandages and aseptic bandages (cloths moistened with wine, alum, copper salts) and about ointment bandages (moistened with oils), drainages and so on. Sponge and dry leaves have been used as bandages, for fixing the bandage — sticky plaster, pitches and exterior cotton bandages. In historic India cotton, vegetative fibers, and so on. have been used as bandage materials. On Scythian bowls (ІV–ІІІ century AD), based within the space of Kerch, there’s a image with a person who’s bandaging a wound.
Within the works of Celsius, bandages moistened with vinegar are talked about. Galen utilized the drainage bandages with bronze tubes.
Avicenna used gypsostarch bandages for treating fractures for the primary time. Within the center ages, bandages with tampons (Roter and Roland), with turunda (Goy de Sholiak) have been utilized. The XVІІІ century was the beginning of the usage of adhesive (plaster) bandages. The artwork of desmurgy reached the best growth within the ХІХ century, within the first place because of quite a few wars at that interval, and secondly because of present idea regarding safety of a wound towards dangerous affect of the atmosphere (particular medical-protective bandage of J. Lister, 1867).
M. I. Pyrogov’s contributed a lot to desmurgy. He repeatedly touched strategy of bandaging in his e-book “Starting of basic subject surgical procedure growth,” wherein he offered his expertise of plaster bandages utility on the battle-field.
The classical ideas developed by the top of the ХІХ century have been assumed as the premise of contemporary desmurgy. New achievements in science, although they didn’t cross over this historic sphere of drugs, however didn’t change it substentially. Bandages are the premise of desmurgy until now.
There are some basic tendencies within the desmurgy growth. First, attempting to make a fancy of brokers for making use of bandages, the aim of which is assist with the work of the medical personnel throughout mass admission of victims.
Second, the appliance of glue preparations (BF-6, furoplast) for safeguarding wounds towards undesirable exterior affect throughout therapy or offering the fixion of bandage materials (cleol, collodium).
Third, the alternative of conventional bandaging materials with ductile one, which gives, concurrently a protecting impact and the introduction of antiseptics on to the broken place because of medical additions to plastic mixes (armored cellulose bandage).
Fourth, the alternative of present gauze bandages with tubular bandages, web rollers, which offer quick and dependable fixion of bandage materials. The aim of wounds bandaging:
— safety of the wound towards dangerous exterior affect;
— prevention of reinfections of wounds;
— typically stoppage of bleeding from the wound;
— battle towards wound an infection by brokers with adsorbing and hygroscopic properties.
In his e-book “Bodily antiseptics”, M. Ye. Preobrazhensky (1894) proved that the bandage materials, which absorbs the contents of the wound effectively, is likely one of the finest methods of discharging an infection from the wound.
If the aim and affect of bandaging to the wound is understood, it’s straightforward to come back to conclusion, which bandaging materials is probably the most appropriate and corresponds to the next necessities:
— it doesn’t irritate the wound or adjoining tissue;
— it doesn’t change its properties throughout sterilization;
— it doesn’t lose qualities throughout a long-term preservation;
— it has a handy kind and, most necessary, — excessive absorbability.
Thus, probably the most appropriate materials for bandaging is cotton, gauze and lignin. These three sorts of bandages have been confirmed in surgical procedure.
White cotton, which is utilized for bandaging, consists of lengthy and skinny fibers. As a way to make cotton appropriate for bandages, it’s essential to degrease it. After degreasing, it’s essential to bleach the cotton a chloral tub and go away it for a while within the open air. After that, it ought to be washed with a weak resolution of hydrochloric acid to neutralize the response. Then, it ought to be washed out with water and dried. A lump of such cotton drowns in water as a result of it absorbs water shortly.
Gray, not degreased cotton, is used within the medical follow for the safety of a sore place towards the exterior influences, for compresses, for placing underneath a plaster bandage, and so on.
The opposite widespread bandage materials — gauze — has bought its identify from the town of origin (the town of Gauze in northern France) the place it was made for the primary time. Gauze is a gentle cotton material product of degreased cotton. There are numerous sorts of gauze; medical follow makes use of 2–3 sorts, which ought to fulfill quite a few necessities.
For bandaging, solely degreased gauze, which is able to absorbing liquids, is appropriate.
Two types of gauze are used within the medical follow: bandaging gauze that’s much less dense, which incorporates 7×8 strings on 1 cm2, and bandaging gauze that’s extra dense, which incorporates 14×14 or 17×17 strings by 1 cm2. The primary one absorbs liquids quicker; the second — slower, nevertheless it’s stronger than the primary one.
Lignin is mechanically and chemically processed wooden of conifers and leaf-bearing bushes. The colour of lignin is white-yellow. It soaks up moist, pus, and simply undergoes sterilization.
The shortcomings of lignin are the next:
It’s not sufficiently elastic and breaks into fantastic items.
Throughout lengthy preservation, it loses its elasticity and crumbles.
It simply breaks underneath the affect of wound secretion.
When moist, it turns right into a steady layer.
Taking this into consideration, lignin is utilized to such wounds which are in want of fixing typically.
Sorts of bandages (in accordance with sort and objective):
Easy, gentle, protecting or medical.
Preasure (hemostatic).
Immovable (immobilizing), transportable and medical.
Extendable (bandages for stretching).
Correctable — for unloading bones and joints, correction oferroneous positions.
Relying upon the fabric, which is used for fixing, the next ones are distinguished:
Mushy bandages (bandage, contour, cravat, sling-like, and so on.).
Exhausting bandages (transport and medical splints, orthopaedicdevices, synthetic limbs, corsets).
Bandages which harden (plasters, zinc-gelatinous, starch, bandages product of polymeric supplies).
SOFT BANDAGES
Mushy bandages are divided into:
Bandage:
— gauze bandages;
— knitted tubular (reticular) bandages;
— elastic textile bandages.
Adhesive:
— artificial glues (cleol, collodion, BF);
— adhesive plaster.
Cravat.
Sling-like.
Contour:
— commonplace contour (suspensors, bandage, retalast, bandage);
— particular person contour (made in case of want).
Bandages. Bandage — an extended strip of gauze or different materials is meant for fastening a bandage or immobilization support-motor equipment (when the bandage is saturated with substances that harden — plaster, starch).
Gauze bandages until nowdays are the essential materials used for bandaging. They’ve completely different width (5–20 cm) and size (5–7 m). Slender bandages are used for bandaging finger and hand, vast ones — for bandaging the abdomen, pelvis, breast, hips.
Bandages after aseptic procedures can be utilized repeatedly. They’re soaked in a 3% resolution of hydrogen peroxide with 0.5% resolution of detergents, washed and sterilized in an autoclave. Bandages are washed in soapsuds on the temperature of 35–37°С, rinsed and dried.
Medical knitted tubular (reticular) bandages are meant for fixing bandaging materials at any a part of the physique. They’re produced as a roll. Not like to common bandages, they aren’t winded arouned however pulled on a broken website of the physique. Ultimately, it fixes the bandaging materials with out impeding mobility of joints.
Elastic textile bandages are utilized primarily in traumatology and sport drugs.
Adhesive bandages are utilized for the safety of open damages and superficious inflamatory processes. They supply fixation of the bandaging materials utilized over the wound.
Cleol consists of rosin — 40 g, 96% ethyl spirit — 33 g, ether — 25 g, and sunflower oil — 2 g.
Collodion contains 4 g of colloxiline, 76 g of ether, 20 g of 96% ethyl spirit. Collodion and nonetheless higher glue BF-6 can be utilized for cover of aseptic postoperative wounds with out gauze, rendering sterile glue on the floor of a small wound (protecting movie).
Plaster. It’s used for the safety of contemporary noninfected wounds as a method of the bandaging materials fixation. Adhesive plaster is used for connection of the sides of wounds. In pediatric surgical procedure — for plaster stretching with fractures of tubular bones.
Cravat bandages. It’s a piece of fabric of a triangular kind. It’s used for the bandaging materials fixation, specifically whereas rendering first help.
Sling-like bandages. These are strips of gauze or every other material incision on each side, meant for holding the bandaging materials on the nostril, chin, and occipital space.
Contour bandages. They’re product of items of fabric in accordance with the profile of a closed bandaged a part of the physique. Contour bandages are mounted with the assistance of sewed tape. Typically for fixing the appendix, contour bandages of the abdomen are used. Elastic reticular bandage (retalast) is product of rubber, braided by a cotton string. This reticular trying like a stocking (from 5 as much as 20 m) seven sizes (0–6) is utilized for fixing bandage materials on any physique space.
Strategy of Making use of Mushy Bandages
The strict following sure guidelines whereas making use of a gentle fixing bandage gives the fullfillment of bandaging necessities:
The affected person ought to be in a handy place; he can lay orsit, if the broken a part of the physique is roughly on the stage of the breast of the rendering help particular person.
A bandaged a part of the physique whereas making use of a bandage isimmobile. The endings ought to be in a physiological place, which gives maximal leisure of the muscular tissues.
The operator ought to be in entrance of the affected person, to see any response to ache which is attributable to the bandage.
The bandage is utilized central (within the path from periphery to the thorax) and begins with a fixing flip.
Throughout typical utility, the bandages ought to be held in theright hand and the free finish (starting) — within the left.
Unroll the bandage from left to proper, with out taking fingers offof the floor which is being bandaged.
Every following flip ought to cowl from half as much as two-thirds ofthe width of the earlier flip.
The calls for to a completed bandage are following:
The bandage ought to reliably repair the broken space till thefollowing bandaging.
The bandage ought to be placed on firmly however not tightly; it shouldnot give feeling of discomfort to the affected person.
The bandage ought to be even, with none wrinkles and nicelooking.
The bandage ought to make even stress upon the corresponding a part of the physique and be motionless.
The knot on the finish of the bandage can’t be on the damagedarea of the physique.
Fundamental Sorts of Bandages
Round bandage. It’s handy when bandaging circularsurfaces. Every following flip covers the earlier one. Sphere of utility: the decrease third of the shoulder, ankle joint. A drawback is that the round bandage can flip round, displacing the fabric.
Spiral bandage. It’s utilized on the extremities, trunk, andthorax. The bandage may be very easy and is shortly utilized, however it could possibly simply slip down.
Spica bandage. It’s utilized for fixation of a large amount ofbandaging materials on the extremities.
Cross bandage. It’s utilized on the physique floor which differin kind (quantity). The bandage kinds a determine 8. It’s utilized on the occipital space.
Spiral reverse bandage. It’s utilized on the humeral joint, shoulder girdle and the areas underneath the armpits.
Turtle bandage (diverges and converges). It’s utilized on largejoints (knee, ulnar, talocrural).
Turning bandage. It’s utilized on the stump after an operation(amputation) of the extremities, fingers or toes.
Т-shaped bandage. It’s utilized on the perineum or axillary space.
Tipes of Bandages In accordance with Localization
Bandages on the top and neck are utilized throughout bleedings. For closing the brow, temporal and occipital areas, round bandages are utilized.
For closing the entire hair space of the top the Hippocrates’ cap and night-cap are utilized, bridle — on the chin space, sling-like bandage — on the nostril, brow, occipital space, cross — on the occipital website.
Bandages on the thorax, humeral zone and the higher extremities. For this objective, spica and cross, cravat and spiral bandages are utilized. The Dezault’s and Velpeau’s bandages are used with clavicle fracture, bruise or dislocation of the shoulder.
The bandage on forearm and shoulder is a spiral turtle one; on the first finger — a spica one; on the opposite fingers — spiral bandages like a mitten.
On radiocarpal joint — a cross one, bandages on the abdomen and pelvis — plaster and spiral bandages. On the pelvis, inguinal space, perineum — variaties of spica bandages.
On the calcaneal space — diverging turtle bandage. On the first toe — a turning one. On the higher and decrease extremities, it’s best to make use of bandages from medical reticular bandage (retalast).
HARD BANDAGES
Exhausting, or retentive, bandages are utilized with the aim to deprive of mobility the broken space of the physique, to supply it relaxation for a very long time and on the sure place. They’re utilized for fractured bones of the extremities for transport or medical immobilization, in addition to for inflammatory illnesses of the extremities, specifically joints (tuberculosis of bones and joints). Immovable bandages are utilized additionally after operations on bones and joints of the extremities with large harm to the gentle tissue.
Customary splints and commonplace fixing materials, extending gadgets, synthetic limbs, and orthopaedical gadgets belong to the exhausting (retentive) bandages. The proper method of exhausting bandages utility is similar as for gentle bandages, however they need to be carried out extra diligently, as a result of they’re utilized for 1.5–2 months and any mistake could deliver deadly hurt to the affected person. It’s essential to look at the situation of the extremities carefully in reference to a risk of uneven stress of the bandage and the formation of necrosis, particularly the place the bones stick out.
Transportable and Medical Splints
They’re largely used for immobilizing the extremities. Medical splints are utilized in hospitals to deal with fractured bones of the extremities. Splints ought to be fairly robust and manageable, present dependable immobilization. They’re constructed from cardboard, wood plates (Diterichs’ splints), plastic, polyethylene (inflatable splints) or steel (Cramer’s and Esmarch’s splints,) for treating fractures by the stretching methodology.
Transport Immobilization
The essential necessities are following:
The splints ought to be sturdy, transportable and easy.
They need to immobilize two-three of the closest joints.
The fixing splint shouldn’t constrain vessels and nerves.
With closed accidents, the splints ought to be utilized over garments. With open — for the primary time, it’s essential to use a sterile bandage to the wound. The splint ought to be utilized strongly and stop displacement of fragments, in any other case giant vessels and nerves will be broken by bone fragments.
Transport splints are divided into fixing and distraction.
Fixing splints present immobilization for components of the physique — commonplace ladder-like Cramer’s splints and Esmarch’s splints. Artificial plastic splints, pneumatic inflatable splints are handy. For the shortage of particular means, improvised means or improvised splints are used.
With a fractured clavicle cotton-gauze rings are utilized. With a broken backbone and bones of the pelvis — lengthy boards and protect, in harm to the hip — Diterich’s splints.
Extension splints have a direct relation to traumatology and shall be described in particulars within the part “Fractures”. They create immobilization and on the similar time present stretching (medical steel splints and equipment).
Synthetic limbs and orthopaedic equipment are produced in orthopaedic factories for long-lasting immobilization of the extremities (orthopaedic footwear or gadgets product of steel, plastic and leather-based).
Bandages which Harden
Plaster, zinc-gelatinous and starch, and likewise glutinous, of uncommon glass and bandages with polymeric supplies belong to this group of bandages, which harden.
Plaster bandages are ready from calcium sulfate, which is rubbed in bandages product of hygroscopic gauze. These days, the medical business delivers ready-made bandages for medical establishments; subsequently a plaster mechanic at traumatology departments has extra time, essential for outlining the standard of the plaster and preparation of the plaster bandage.
The standard of the plaster is decided as follows: in a tray a small quantity of plaster powder is blended with heat water within the ratio of two:1. A ball is product of plaster resolution, which should harden in 5–10 min and stay intact when dropped on the ground. If the ball breaks, the plaster just isn’t appropriate to be used. Scorching water accelerates the hardening technique of plaster.
In traumatology, there are particular plaster rooms for making use of and eradicating plaster bandages. They’re outfitted with particular stock and devices. Plaster bandage or longets are soaked in a basin with heat water after which await the excretion of air blisters to finish. Every plaster bandage take out by each ends with two fingers.
The bandage is wrung on either side with a view to get the water out. The wrung bandage is circularly rolled up on the ends. Earlier than making use of the bandage, the pores and skin is greased with Vaseline or a cotton stocking is placed on, leaving the fingers open. The extremities are stored on the impartial place. For immobilization of the extremities throughout a fracture, an unpadded plaster forged is utilized, in different circumstances — the protruding space of the extremity is roofed with a cotton-gauze (padded bandage). A 5–6-layer bandage is stable sufficient. The situation of the extremity ought to be watched for 2 days after making use of the bandage. If the extremity will get chilly, ache happens, the plaster bandage ought to be incision with scissors or a particular noticed. Every plaster bandage is marked with an indelible pencil. It incorporates the schematic picture of the fracture or the inflammatory focus, the bandage utility and removing date.
The plaster dries inside 24 h. The bandage is dried with a cell electrical heater.
There are the next sorts of plaster bandages:
Round dense ones — for immobilization of the extremitiesand trunk in fracture.
Fracture brace is utilized on one joint or a sure section ofthe extremity, which gives relaxation and immobilization throughout contusions, fractures, inflammatory processes.
Slab of plaster is utilized with bruises, fractures and inflammatory processes. It may be posterior, palm (anterior) and P-shaped.
Slab of plaster and circulating bandage is a splint, which isfixed by round plaster bandages in bones fractures.
Fenestrated and bridge-shaped bandages are used for the therapy of wounds with the immobilization of the extremities. For the reliability of the fixion of the extremities within the place of the hardening plaster bandages with spacer are used.
The hinged-plaster bandage is utilized for coaching movementsin the joint.
Plaster corsets, collars, bandage-beds are utilized within the therapy of orthopaedic illnesses, power inflammatory illnesses of the bones, throughout a particular interval after a fractured spine, and so on. The plaster bandage is the optimum sort of bandages which harden. The zinc-gelatinous bandage is utilized through the therapy of varicose ulcers of the decrease extremities, which don’t heal simply, purulent wounds, penalties of fractures.
The zinc-gelatinous mass of Unna is dissolved in a water tub; they soak with it the turns of bandages utilized to the pores and skin of the definit section of the extremity. Whereas making use of the extension bandages, round turns of the bandage (the primary layer) are carried out; they’re rigorously saturated with paste, longitudinal strips of gauze are placed on (the second layer) for extension traction, and they’re mounted with round turns (the third layer), diligently saturating the bandage with paste. The zinc-gelatinous bandage is ready by the next recipe: zinc oxide — 100 g, gelatin — 200 g, water — 300 ml, glycerin — 400 ml.
Starch bandage is ready from starchy gauze bandages. The approach for making use of is much like plaster one. Starch bandage is much less stable, however its utility is less difficult.
Adhesive bandages product of uncommon glass (siliceous sodium), celluloid, and dextrin are largely used when making use of replacable bandages (corsets, splints, and detachable joint-immobilizer).
Bandages product of polymeric supplies (plastubol, bumetol, and so on.) are utilized by means of spraying aerosol with these substances on wounds, burns or postoperative wounds. For a number of seconds after spraying the aerosol, a clear protecting movie, which gives not solely operate of the bandage but in addition visible supervision of the wound, seems. When introducing medical preparations into the construction of the aerosol, additionally they have a direct medical impact.
The bandage with villiage cheese and 1/8 a part of liquid ammonia or 10% of KOH will be utilized within the villiage due to the shortage of different hardening brokers.
Celluloid bandages are made as follows: celluloid is dissolved in acetone and glue, which was fashioned, and grease the gauze bandage.
Attainable problems because of unsuitable utility of a bandage which hardens: hypostases, lower in muscular drive and immobilization, impairment of blood circulation.
A scholar ought to know and have the ability to apply such bandages as: “night time cap”, “Hippocrates’ cap”, bandage on the occipital space, on each eyes, Dezault’s bandage, “bridle”, Velpeau’s bandage, sling bandage, bandage on the mammary glands, occlusion bandage with harm to the thorax, spica bandage on the humeral joint, a “turtle-like” bandage on the ulnar joint and a “knight glove”.