From Big Medical Encyclopedia

TAMPONADE (fr. tamponnade, from tampon a plug, a stopper) — filling with the medical purpose of a wound or the affected cavity of an organism gauze tampons, biological or synthetics.

For T, most often use gauze tampons (see. Dressing material ), edges to-rykh turn inside for prevention of hit in a wound of gauze threads. Tampons 4 — 5 cm wide, 20 — 40 cm long are most applicable. In quality biol. a tampon sites of a big epiploon, a muscle, fatty deposits (in the form of free rags or on a leg) or the special biol. antiseptic tampons (B.AT) made of plasma of human or bull blood with addition of nek-ry pharmaceuticals can serve (e.g., penicillin, Furacilin, calcium chloride, gelatin, etc.). From synthetics for T. use the resolving haemo-static viscose (oxycellas), haemo static paste (oksigemodeks), etc.

T. apply at wounds and operations to a stop of bleeding from deep wounds when the bleeding point is difficult available, at treatment of purulent wounds and the opened sacculated abscesses.

T. for a stop bleedings (see) use at damage of sine of a firm meninx, extensive injuries of a liver, during operation for acute pancreatitis, after the cholecystectomia and appendectomy which were complicated by bleeding at profuse uterine bleedings (T. a uterus and vaginas), unrestrained nasal bleeding (see), etc.

Fig. 1. Diagrammatic representation of a hard tamponade of a wound cavity and its branches gauze tampon.
Fig. 2. The diagrammatic representation of a tamponade of a wound across Mikulich: the wound cavity is covered a gauze bag (1) which then is hardly filled with tampons (2)

During the packing of a wound for a stop of bleeding the cavity it is hardly filled with gauze tampons (fig. 1), trying to obtain a mechanical prelum of the bleeding vessels that gives positive effect at capillary and venous bleedings. At extensive damages of parenchymatous bodies and big deep wounds apply a tamponade across Mikulich, at a cut enter the square, put in several layers gauze napkin with a silk ligature into a cavity of a wound (or the sewn strip of a gauze) in the center. This napkin cover walls and a bottom of a wound and a cavity of the formed gauze bag fill with tampons (fig. 2). In process of treatment of tampons with exudate they are periodically replaced new.

When need for a tamponade disappears, at first delete tampons, and then, carefully sipping for a silk ligature, and a gauze bag.

For increase in haemo static action gauze tampons impregnate with various styptic means (see) or apply together with a fibrinny sponge (see. Fibrinnaya sponge, film ), haemo static viscose, gemosta-tnchesky paste, BAHT, etc.

Styptic gauze tampons delete in various terms, but not earlier than on second day after operation, carefully tightening and loosening them. In the presence of indications after removal of tampons make a final stop of bleeding.

Fig. 3. A tamponade of a bullet wound of the right hepatic lobe the site of a big epiploon on a leg (it is specified by shooters).

T. with use biol. the fabrics rich with a thrombokinase, apply more often to a stop of bleeding at internals operations. E.g., fixing of the site of a big epiploon to the place of seams on a liver (fig. 3) is effective. T. a muscle widely use for plastic closing of bone cavities (see. Osteomyelitis , Plastic surgeries ).

Use of T. in treatment of purulent wounds it is based on the sucking-away action of a gauze, thanks to Krom wound exudate comes from a wound to a bandage. In these cases tampons enter rectilinearly a packer into depth of a wound, for filling the cut is used by the necessary number of gauze strips. The ends of tampons shall act from a wound on 3 — 4 cm; in order to avoid an excess they are surrounded with gauze napkins. However the sucking-away action of a tampon continues not further 2 — 3 days, further the tampon slimes, loses a capillarity, disturbs a wound repair and it should be replaced that is connected with damage of granulations and an injury for the patient. For simplification of replacement use the tampons surrounded with the strip which is cut out from a rubber glove with openings. At treatment of purulent wounds of T. usually combine with topical administration of antibiotics, use BAHT, proteolytic enzymes, etc.

In practice of modern surgery to T. purulent wounds resort generally when it is necessary to delimit a suppurative focus, napr, in an abdominal cavity, from not infected its part. In these cases abscess is surrounded with the delimiting tampons, the cavity it rykhlo is tamponed separately and drained (see. Drainage ); the delimiting tampons delete on 8 — the 10th days after operation when around them the reliable unions interfering infection of an abdominal cavity are formed. In other cases of T. prefer drainage of wounds with active aspiration wound separated (see. Aspiration drainage ).

Bibliography: Alexandrov H. M. Clinical use of a biological antiseptic tampon, JI., 1957, bibliogr.; The application guide of blood and blood substitutes, under the editorship of A. N. Filatov, L., 1973; Creak and chenko F. Urgent surgery of an abdominal cavity, Kiev, 1974; V. I Pods. Purulent surgery, M., 1967.

D.F. Skripnichenko.