Chapter 6: Plastic Surgery. - Famona Site

- increased alkalinity in wounds- destruction of bacteria in guts of maggots- enzymatic liquefaction of necrotic tissue- mechanical cleansing of bacteria by serous exudate caused by irritating effect ofmaggots in wounds- secretion of agents like allantoin, ammonia and CaCO 3- allantoin has long been known to have a healing effect on wounds.The disadvantage of this method was mainly the irritating and tickling or itchingsensation caused by worms crawling in the wound, skin or clothing of the patient.CommentDebridementR GrabeAs regards debridement following trauma, I would suggest that it is mandatory to usea theatre hose connected to a tap. This will ensure a larger flow of water and contribute moreeffectively to the mechanical cleansing of the wound.To remove the grease within the wound by ether or acetone will cause more damageto the tissue by these chemicals then the tar or grease in the wound itself. Nothing more thanwater and antiseptic soap should enter the wound.The surgeon should scrub as for a major operation and put on surgical gloves beforedoing a debridement. The wound should be covered with large sterile swabs while thesurrounding skin is scrubbed and cleansed. After this has been done, the surgeon should carryon with irrigation of the wound itself. This is followed by the formal debridement operationand the surgeon should scrub again and put on gloves and gown as for a major procedure.Even large fragments of bone totally devitalized should be excised and not left in thewound. Leaving large fragments contribute to secondary infection, and these fragments do notreally serve any purpose. In these specific cases, the healing of soft tissue is paramount andis encouraged by the use of an external fixator.8