Suturing/Litigation of an Artery
Suturing/Litigation of an Artery
Certain of these larger arteries require ligation. The ligation of an artery calls for a certain amount of surgical skill, but if it is necessary to save life you can do it. Surgeons now use sterilized catgut for the purpose, but silk can be used as well, taking care to leave sufficient end hanging out of the wound to remove it by.
After having made compression and controlled the hemorrhage, clean out the wound and loosen your tourniquet until the blood spurts. Locating the artery, grasp it in the bite of the hemostatic forceps. Cut off a short piece of silk and tie it loosely around the forceps. Have someone pull up on the forceps and at the same time with your forefingers slip the knot down over the end of the cut vessel. Tie tight and remove your forceps.
This procedure will be necessary only in case of injury to large vessels. Smaller arteries can be controlled by the means hereafter described, or by placing a heavy pad of gauze over them and making compression with a tight bandage. The blood will become entangled in the meshes of the cloth and form a clot.
Incised wounds inflicted with sharp instruments will be found to comprise practically all the injuries occurring in the woods. The method of treating one will illustrate that of dealing with all. Let us suppose that in cutting firewood the camper has had the misfortune to drive a sharp ax into his instep (a quite common accident). The blood spouts at once in a very alarming manner. He hobbles to the camp and removes his shoes. An ugly gaping wound appears, from the bottom of which blood is jetting, indicating that an artery has been severed.
The first thing necessary is to stop the blood. Take a handkerchief or other cloth and tie it about the ankle rather loosely, place a small stick or a table fork beneath it and twist. In a few turns you will note that the blood is flowing with less force and shortly will cease altogether.
When the bleeding has been entirely controlled get out your surgical kit and throw a pair of the hemostatic forceps into the boiling water. After they are sterilized wash the wound free from blood with pure water. I will add in this connection that spring water in the mountains is practically sterile and can be used for washing wounds without any danger of infection.
After the wound is clean have someone slightly loosen the tourniquet. As he does this watch sharply for the jet of blood that will locate the cut artery. As soon as you see it grasp it with the forceps, lock them, and leave them in place. The compression of the forceps while you are getting ready your other instruments will seal up the vessel so that when you remove them it will not bleed any more.
Take two of your full curved needles, at least two inches long, and thread them with quite coarse silk, cut off a piece of your gauze and run the needles through it. Place the needles thus prepared, the needle holder, shears, and the other pair of hemostats in a vessel and boil. In the meantime make up a solution of the bi-chloride, using the antiseptic tablets for that purpose.
Wash your hands well and rinse them in the bi-chloride solution. Clean out the wound, taking great care to remove all clots. With one of the threaded needles in the grasp of the needle holder begin at the upper angle of the wound, about half an inch from the end. Pass the needle down through the flesh one-fourth of an inch from the edge, carrying it well toward the bottom and making it enter the wound near the bottom and re-enter the flesh on the opposite side, pass up through and out an equal distance from the edge. Cut the thread off and lay the two ends out of your way, leaving, of course, sufficient to tie with when the time comes.
Place your row of stitches half an inch apart all down the wound. When all the stitches are in place you may begin to tie. Take the two ends of the first stitch in your hands and lift up on them; this will bring the edges of the wound together. Tie the thread, turning the first knot under twice to prevent its slipping. After all the stitches have been tied take the handle of your scalpel or the forceps and raise the edges of the skin, which will have rolled in, until they meet each other. This is necessary, as where the skin is rolled in it will not heal readily and leaves an opening for the entrance of bacteria.
Sponge off all the free blood and dust well with surgical powder. Place a pad of gauze that has been soaked in the bi-chloride solution over the wound, cover that with a wad of cotton and the cotton with a piece of oiled silk, bandage over all, and do not molest for at least three days.
After five days you may remove your stitches in this manner: Cut the stitch near the skin on one side, grasp the knot in the bite of the forceps and pull it out. Be careful not to try to pull the knot through the flesh, and do not leave any end on the part you do pull through the flesh, as it may carry infection down into the wound.
Moody, Charles Stuart. Backwoods Surgery & Medicine. New York: Outing Pub., 1916. Print.
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