When haemorrhage has ceased, the time will have arrived for cleansing the wound and preparing it for adjustment. This should be done with gentleness and care, lest bleeding be induced to recur.
Everything brought into contact with the wound should be clean, and rendered aseptic by suitable dressings. The removal of all adherent blood and foreign matter may be effected by allowing a stream of cold carbolized solution to flow over the wound, and if necessary the surface should be carefully wiped over with a loose pledget of wool or lint soaked in carbolized water or some other disinfectant. In penetrating wounds inflicted by stakes and other sharp implements, broken splinters are sometimes left behind, and unless sought for and removed will prove a source of lasting trouble. They invariably give rise to profuse suppuration and discharge of matter, which only ceases when the offending body has been removed or passed away.
Fig. 411. - Various Methods of Arresting Bleeding.
1, Probe lifting an artery while the forceps hold back its sheath. 2, Needle inserted and threaded. 3, Tying a ligature. 4, Correct knot for a ligature. 5, Effect of a ligature on an artery: a, the severed ends of inner coat turning inwards; b, b, blood-clots. 6, Checking bleeding by a tourniquet. In the illustration a pad is placed on the artery and bound down by a bandage; a stick is used as a tourniquet, and is kept in position by a second bandage. 7, Closing an artery by torsion. The artery is seized with one pair of forceps and twisted about twelve times by the other to sever the inner coat.
In some instances wounds containing fragments of foreign substances will heal over, only, however, to break out again after the formation of an abscess, either at the seat of the original wound or in the more immediate vicinity of the impacted body.
To bring the divided parts of a wound into their original position is a most important step towards effecting a speedy reunion, but it is only in the case of incised wounds, where the surfaces are level and clean-cut, that this is capable of being efficiently carried out, and even here the greatest care is sometimes needed lest the advantages offered be lost. This is. especially the case in deep wounds, where some difficulty is experienced in keeping the deeper parts of the apposed surfaces together. If for want of support they should fall away from each other, while the more superficial part of the wound closes over, an opportunity is offered for matter to-accumulate between the disconnected parts below, and ultimately to break through the united tissues above.