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New Zealand Medical Services in Middle East and Italy

Operative Technique

Operative Technique

Two tables were used in the theatre. Improvised methods of concentration of electric light were used and standard lights were sometimes available. Arm boards were essential for the giving of page 456 blood and also pentothal injection. Suction apparatus, generally improvised, was also always used. Plain soap and water was used for skin cleansing and shaving was freely resorted to. Iodine was the usual skin application. The surgeons wore macintosh overalls, caps, and face masks. Gloves were generally worn but not always changed for each operation. Macintosh and rubber guards were commonly used, but for abdominals the full surgical technique with linen guards was used. There was great wear and tear on surgical instruments due to the constant boiling. Fine thread was generally used for ligatures.

As regards wound treatment, the removal of skin had been reduced to the minimum and only definitely damaged and devitalised tissue was removed. All avascular and badly traumatised muscle, however, was carefully excised as a precaution against anaerobic infection. Only definitely loose fragments of bone were ever removed. Free and, if possible, dependent drainage was provided in all large wounds associated with much muscle or bone damage. Relief of tension was of the greatest importance and incision, both longitudinal and sometimes transverse, of the fascia was regularly carried out. Foreign bodies, especially clothing, were removed if readily accessible. If deep muscular gangrene was present whole muscle groups were removed, and if the whole limb was gangrenous amputation was carried out. Ligature of the vein in addition to that of the artery was being given up in the treatment of injuries of the main vessels. Injured nerves were dealt with only by approximating the severed nerve ends. The surgeon regularly wrote up notes after the operation, both in the operation book and on the field medical card.