BANDAGES — the means for treatment of damages and diseases consisting in imposing on the struck center of a dressing material and its fixing in the field of defeat or in an immobilization of the most struck area.
Dressing material (see) and part P. fixing it (see. Desmurgy ), being usually two independent parts P., can be combined in nek-ry types of a dressing material (e.g., medical plasters, self-adhesive bandages); if P. is intended only for providing an immovability of the struck part of a body, it can consist only of one fixing part.
Bandages happen soft (gauze, made of cloth, from synthetics), hardening (plaster, starched, from liquid glass, synthetics, etc.) and rigid (tires from various materials). Soft P. on a way of fixing divide on bintovy, Kosynochny, prashchevidny, T-shaped, planimetric, tubular (knitted and mesh) and stickers (adhesive, Kleolovy, collodion, etc.).
P.'s use at a glecheniya of damages represented, apparently, the first rational grant known long before emergence of the first medical schools. Connect development of various options of the fixing P., a part with a name of Hippocrates from to-rykh in maloizmenen-number a look remained up to now. Medicinal influence by means of bandages is described in A. Tsels and K. Galen's works. In 18 — 19 centuries expediency of use for P. of the materials having the soaking-up ability was scientifically proved (lints from cotton rags, linen and hempy hemp, in the subsequent — a gauze and cotton wool). In the 70th the aseptic listerovsky dressing was widely adopted 19 century, further P.'s improvement went hl. obr. on the way of research effective to lay down. levers on a wound and new (in particular, synthetic) dressing materials.
Strict classification of P. is absent; distinguish their following types: dry aseptic, protective, antiseptic (bactericidal), hypertensive, haemo static, oily-balsamic, occlusal, motionless, elastic. Items produce standard and improvised.
The dry aseptic bandage is applied a wound during the rendering the first medical aid and after operation as temporary protection of a wound against secondary infection, traumatizing, cooling and other adverse effects of the environment. After processing of a wound antiseptic drugs on it impose 2 — 3 gauze napkins (or a vatnomarlevy pillow) coming on healthy fabrics not less than on 4 — 5 cm. If P. is imposed on a wound with plentiful purulent separated, then use bigger quantity of napkins and a wadded and gauze pillow. Replacement of cotton wool with a lignin is admissible. The indication to P.'s change are its pollution, need of audit of a wound, plentiful treatment of P. separated from a wound.
The protective bandage is counted on longer and reliable protection of a wound against secondary infection and negative impacts of the environment, than it is provided at dry aseptic to the Item. It is carried out in the form of the usual aseptic P. covered with a liquid-tight layer (an oilcloth, a polyethylene film, the napkin impregnated with indife-rent oil, napr, liquid vaseline). Also P. belongs to protective, edges it is imposed after drawing on a wound of the aerosol forming after evaporation dense, impenetrable for microbes, an elastic film; such film can be received, using Furaplastum (with perkhlorvinily), etc. Most often protective P. is applied to treatment of wounds in a stage of dehydration at well-marked healthy granulations and scanty quantity of separated.
The aseptic (bactericidal) dressing is applied to treatment of contaminated wounds. As antiseptic agents use an iodoform, streptocides, antibiotics, Furacilin, Degmicidum, roccal, a dimethyl sulfoxide, etc. Often together with antiseptic agents use proteolytic enzymes and other drugs (see. Bandagings ).
There are several kinds of antiseptic P.: dry (on a wound fill a dry antiseptic agent, and from above impose dry aseptic P.); wet drying (on a wound impose the gauze napkins impregnated with solution of an antiseptic agent and close dry aseptic P.); Items with use of aerosols, P. using napkins, to-rykh are included in molecules of fabric antiseptic drugs; Item of the longest bactericidal action (e.g., Livian, Legrazol, etc.); The items possessing the antiinflammatory, anesthetizing and antiseptic action.
The hypertensive bandage promotes outflow of wound exudate from a wound. Its sucking-away action is caused by the solutions impregnating tampons, osmotic pressure to-rykh above, than pressure in liquids of body tissues and wound separated. Hypertensive P. represents one of ways of physical antiseptics; it is applied to treatment of purulent wounds with plentiful quantity separated, and also at sluggish epithelization of a wound. In 6 — 12 hours after imposing (depending on quantity wound separated) P. practically ceases to work. On technology of imposing hypertensive P. does not differ from wet you - sykhayushchey antiseptic in the Item. As hypertensive solution 5 — 10% solution of sodium chloride are most often used.
The haemo static bandage is applied in two options. At venous and capillary bleeding impose the so-called pressing P. representing dry aseptic P., atop a cut hardly bandage a lump of cotton wool. This P. was widely applied in 19 century; for squeezing of vessels then special pilots were made. If haemo static P. is applied to a stop kashshlyarny, the small arterial, venous or mixed bleeding, then the antiseptic tampon, an absorbable gelatin sponge or dry thrombin are used biol.
Oil - the balsam bandage represents medicinal P. with the ointment offered by A. V. Vishnevsky and called by it an oily-balsamic antiseptic agent. It can be applied to treatment of inflammatory processes, burns, freezing injuries.
The occlusive (pressurizing) bandage provides isolation of the struck area of a body from water and air. These P.' idea was realized for the first time in the isolating Lister's bandage. In sovr, surgeries understand a way of dissociation by means of P. as the term «occlusive bandage» of a pleural cavity and external environment at the wounds of a thorax complicated by open pheumothorax (see). For providing occlusion directly on a wound and surrounding it (in a radius of 5 — 10 cm) skin is imposed water - and air-tight material (the big gauze napkins impregnated with a liquid paraffin, a wrapper from a first-aid dressing kit, a sterile polyethylene film, etc.) which is densely fixed gauze bandage. Occlusion can achieve also, having stuck a wound with the wide strips of an adhesive plaster imposed like a tile; for bigger reliability, especially at wet skin, from above impose dry aseptic the Item.
Motionless bandages apply to providing a full or partial immovability of the struck part of a body (see. Immobilization ) or immovabilities with extension (see). Treat them tire (see. Sheena, splintage ) and the hardening Items. From the hardening P. are most widespread plaster (see. Plaster equipment ). Enter surgical practice of P. with use of the synthetics (polivik, the made foam polyurethane, etc.) becoming plastic at warming up in hot water and hardening after imposing on an extremity. Other hardening P. (with use of starch, glue, celluloid, liquid glass, etc.) have historical value; orthopedists in children's practice sometimes resort to them.
The starched bandage of Seten is applied over a wadded lining, using the bandage impregnated with starch paste; bandage an extremity from the periphery to the center. For increase in durability of P. between layers of bandage stack strips of a cardboard. Starched P. dries slowly in this connection there is a risk of secondary shift in the course of hardening; it is less strong, than plaster.
The glue bandage is prepared from bandage made of cloth with a covering from joiner's glue. Before P.'s imposing bandage lower in hot water and impose on an extremity over a gauze lining. Drying of a bandage requires apprx. the 8th hour.
The bandage of celluloid is done by putting solution of celluloid in acetone over the courses of gauze bandage.
The bandage from the Shrauta liquid glass is applied an extremity on a layer of cotton wool (batting, a flannel), fixing it by the bandage (3 — 5 layers) impregnated with liquid glass (saturated water solution of sodium sulfite). The item hardens in 4 hours.
The flexible cast is intended for ensuring uniform pressure upon tissues of an extremity for the purpose of the prevention of hypostasis because of stagnation of blood and a lymph (see. Lymphostasis ). It is applied at varicosity (see), a posttromboflebitichesky syndrome (see. Phlebothrombosis ), etc. Elastic P. can be made on zinc - a gelatinous basis using Unna's paste. Glycerin (6 h) and a distilled water (2 h) are a part of paste of Unna zinc oxide and gelatin (according to 1 h). Paste has a dense elastic consistence. Before the use it is warmed on the water bath (without bringing to boiling) and with a wide brush applied on each layer of the gauze bandage imposed on an extremity. Usually P. do of 4 — 5 layers. P.'s drying lasts 3 — 4 hours. Other kind of elastic P. is imposing of knitted elastic or mesh elastic bandage. Bandaging by elastic bandage is carried out from the periphery to the center for type of a spiral bandage. Apply also finished products like elastic stockings, elastic kneecaps, etc.
The complications connected using P. most often are caused by the irritating influence nek-ry of them on skin and technical errors at their imposing. So, adhesive and colloid P. irritate skin, adhesive P. so densely sticks to hair that its removal is usually accompanied by pain; hard imposing of bandage on an extremity causes pains, the posineniye and hypostasis are lower than the Item. The wrong imposing of the hardening and tough P. which it is usually long remain on a body of the patient, shifts of bone fragments at a change can become the reason of disturbances of a podvrgzh-nost in joints, decubituses in the field of bone ledges, etc.
Bibliography: Atyasov N. I. and the Raut N. I. Tekhnika of a desmurgy at damages of soft tissues and fractures of bones (The medical atlas), Saransk, 1977; Billroth T. The general surgical pathology and therapy in 50 lectures, the lane with it., SPb., 1884; Quickly N. I. Influence of various concentration and combinations of solutions of Dimexidum (dimethyl sulfoxide) on a current of a wound process, Klin, hir., No. 1, page 64, 1979; Tauber A. S. Modern schools of surgery in the main states of Europe, book 1, SPb., 1889; F r and dl and N d M. O. Guide to orthopedics and traumatology. M, 1967; Biological actions of dimethyl sulfoxide, ed. by S. W. Jacob a. R. Herschler, N. Y., 1975; Lister J. On the antiseptic principle in the practice of surgery, Lancet, v. 2, p. 353, 1867.
T. X. Kutushev, A. C. Libov.