New Zealand Medical Services in Middle East and Italy
Treatment of Different Injuries
Treatment of Different Injuries
Joints: No operative treatment was carried out in small perforating and penetrating wounds. Large wounds were excised, large accessible foreign bodies were removed, and the patella, if seriously damaged, was completely excised. The synovial membrane was sutured but not the skin.
Heads: Careful excision of the wound down to the bone was performed. Loose bone was removed and the skull nibbled away to expose the dura and brain wound. A combination of syringing and suction removed the pulped brain and accessible bone fragments or foreign bodies. Sulphadiazine was applied to the wound and also given intravenously following operation. The wound was sutured in two layers with thread and a small stab drain inserted for a few days. A plaster cap was used to keep the dressings in place. Diathermy was used to control bleeding.page 457
Eyes: Corneal spattering was very common, as were penetrating wounds by small foreign bodies. The removal of these by the electromagnet was very difficult, many fragments being non-magnetic.
Jaws: Fractures were dealt with by dentists skilled in the application of inter-dental splints, or extra-dental splints, and pins were used in combination with a head plaster.
Chests: Large and also sucking wounds were dealt with by excision. A vaseline gauze pack kept in place by sutures was used to close the sucking chest. Ligature of bleeding intercostal arteries was sometimes necessary. Aspiration was carried out when respiratory distress was present.
Abdomens: These cases were given first priority. Diagnosis was often difficult, especially as wounds such as buttock and chest wounds were often associated with intra-abdominal injury. Catheterisation was always done before operation as a precautionary and diagnostic measure. Exploration was carried out either through the excised original gunshot wound or more normally through a separate incision. Lateral transverse incisions were sometimes used but vertical central incisions were generally employed. Exploration was not always carried out in liver or kidney injuries. Examination of the abdominal contents was carried out methodically, except when it was certain that the injury was strictly localised. The small intestine had to be particularly well looked at as multiple injuries were common. Suture of the perforations was always preferred to excision because of the lower mortality. Simple one-layer suture was carried out, even when excision had to be performed, with some extra stitching if time warranted it. Suture of the colon was done only, and that infrequently, in very small lesions of the caecum and right colon. In all other cases the injured gut was exteriorised and a colostomy with a spur formed. In lower sigmoid and rectal injuries a left side colostomy was made. Colostomy had been carried out in cases of severe buttock wounds to ensure cleanliness of the wound, but it had been realised that it was too heavy a price to pay and the practice had been discontinued, except when the rectum itself was involved. Liver wounds were found to require little treatment. Only very rarely was packing or suturing required to stop bleeding. Minor kidney injuries required no treatment. In severe cases exploration followed by nephrectomy or drainage was carried out. Association with a colon injury made nephrectomy advisable. Bladder injuries were sutured and suprapubic drainage was instituted, as it was for spinal cord injuries and urethral damage.
Wound Treatment: Primary skin suture was carried out for scrotal and penile injuries and also for wounds of the head and abdomen. In all other wounds there was no primary suture, and tulle gras or page 458 vaseline gauze dressings were applied following wound toilet. The ordinary wounds were dusted with sulphanilamide and then a vaseline gauze dressing applied. Sulphanilamide by mouth was then given regularly for six days, charts being utilised to ensure proper dosage.
Burns: Serious cases were treated with serum, morphia, and rest. Cleansing and dressing of the burns was left till resuscitation had taken place, and often only part of the burnt area was treated at a time and then only gently cleansed with saline dabs. Sulphanilamide powder or ointment was used, followed by tulle gras dressing. Tanning had been completely given up. The need of whole blood transfusion after the first few days was recognised, the haemoglobin often by that time having been reduced to 60 per cent or less.