In in France barbers were banned from practicing surgery. Two years later in England the guilds were divided once more when King George II established the London College of Surgeons and the job of a surgeon was viewed no longer as a trade but a profession.
The Company of Barbers remained, but gradually the medical role of the barbers dwindled. From their medieval beginnings the services of the barbers increased, and their need was never greater than during the thirteenth and fourteenth centuries when the plague, the Black Death, hit Europe. Known as the Flying Barbers, the barber surgeons traveled from town to town, setting up camps on the outskirts and holding surgeries where their attempted cures mainly consisted of bloodletting.
Probably they did more harm than good, but there was no one else for the people to turn to. At this time, the barber surgeons still practiced the medieval system of medicine based on the four humors—phlegm, blood, yellow bile, and black bile. Any sickness was attributed to an imbalance of these humors and the barber surgeons would compare a urine sample against a urine chart to diagnose the cause of illness and thence decide from which part of the body to draw blood.
The treatment of bloodletting, using leeches, was to re-establish the balance of the humors. Even into the nineteenth century, bloodletting remained popular as a cure for many ailments. Leeches were the means of drawing blood, but as the availability of leeches declined due to overuse, the barber surgeon attained the ability to extract blood from a vein. Trepanation, the art of drilling a small hole in the skull to just above the membrane surrounding the brain, was also common practice.
Initially it was believed that this would allow the demon inflicting the patient to escape. This procedure of trepanation was used on patients with epilepsy and conditions recognized today such as autism.
As with bloodletting, trepanation caused more harm than good and was certainly no cure. During the centuries that followed the Black Death, the skills of the barbers and surgeons were regarded for a long time as much the same, but despite the amalgamation of the guilds in and as medical knowledge increased, the two entities were beginning to establish themselves as separate professions.
One of the prime movers in the separation was the sixteenth century French surgeon, Ambroise Pare. Nonwoven Surgical Sponges-Nonwoven fabrics have been developed that are suitable alternatives to woven cotton gauze for use in wound cleaning, wound dressing, and tissue-handling.
These nonwoven fabrics depend on dense entanglement of their synthetic fibers Dacron, rayon, etc to provide the fabric with an acceptable tensile strength approaching that of woven cotton gauze. They typically offer greater absorbent capacity than cotton gauze sponges of comparable bulk, while generating less lint. Specialty versions of the nonwoven sponges are available prefenestrated for IV tubing or draindressing procedures.
Additionally, a new universal sponge which combines the best attributes of woven and nonwoven gauze, has been created from a new fabric technology. Mirasorb Johnson and Johnson is made from a cotton blend, is more absorbent and resilient than woven gauze, provides less adherence to healthy tissue, and reduces wound damage and tissue trauma upon removal.
The ravelproof, selvage edges on both sides eliminate all loose threads. These strips are obtainable in sterile form packed in sealed glass jars. Nu Gauze Packing Strips are packaged in polystyrene containers. Gauze Pads or Sponges are folded squares of surgical gauze. These are so folded that no cut gauze edges or loose threads are exposed.
This prevents loose fibers from entering the wound. The pads are folded such that each size may be unfolded to larger sizes without exposing cut edges or loose threads. Sterilized packages of these frequently used allgauze sponges are available in tamper-proof packages. Such sterile units particularly are well-suited to the numerous tray sets prepared in hospitals.
X-ray Detectable Gauze Pads are similar to all-gauze pads but contain inserts treated with barium sulfate. They are nontoxic, soft, and nonabrasive. They remain permanently detectable because they neither deteriorate in the body nor are affected by either sterilization or time.
Examples of X-ray detectable sponges include Vistec and Kerlix unique, crinkleweave, soft, and absorbent , both manufactured by Kendall. Ray-Tec X-Ray Detectable Sponges Johnson and Johnson contain a nonabrasive vinyl plastic monofilament that gives a characteristic pattern in the X-ray. Composite absorbent dressings have been developed for specific purposes. They usually consist of layers of absorbent gauze or nonwoven fabric with fillers of cotton, rayon, nonwoven fabric, or tissue paper in suitable arrangements.
Composite sponges have gauze or nonwoven fabric surfaces with fillers of cotton, rayon, nonwoven fabric, or absorbent tissue. Each combine consists of a nonwoven fabric cover enclosing fiber with or without absorbent tissue.
They also may incorporate a nonabsorbent layer of cotton, tissue, or plastic film to prevent fluid from coming through to soil liners and bedding, though some combined dressings are entirely absorbent. The edges are folded in and hemmed. A desirable feature of one type is an X-ray-detectable insert so firmly incorporated into the gauze that it cannot become detached.
Treated with barium sulfate, the monofilament is nontoxic and, were it to be left inadvertently in situ, would cause no more foreign-body reaction than an ordinary dressing. Napkins that have repellent tissue on the side and back surfaces of the napkin usually are preferred because of their greater fluid-holding capacity. The napkin cover generally is made from a nonwoven fabric or a nonwoven fabric supported with an open-mesh scrim.
Packaged, sterilized napkins are available and used generally to reduce cross-contamination possibilities. They generally offer advantages over paper in wet strength and abrasion resistance, plus having better cleaning ability.
Their advantages over cloth are reduced laundry expense and cross-contamination possibilities. These pads are made using nonwoven fabric. Two sides are enclosed to prevent the cotton from escaping and the pad from distorting. When desired, the pad may be folded and used as a pressure dressing. They are sealed in individual sterile envelopes. Such pads cost less than the average hospital-made product and provide a neat, clean, easy-to-handle pad that is changed quickly and easily disposed.
Disposable briefs are available Johnson and Johnson, Kendall. Machine-made cotton-tipped applicators are uniform in size, resulting in no waste of cotton or medications. The cotton is attached firmly to the stick and may be sterilized readily without affecting the anchorage of the cotton. They are available in 3- or 6-inch lengths.
They may be inelastic, be elastic, or become rigid after shaping for immobilization. It is prepared from Type I Absorbent Gauze in various widths and lengths.
Each bandage is in one continuous piece, tightly rolled and substantially free from loose threads and ravelings. They are supplied in the same widths as the regular gauze bandage. Muslin bandages are very strong and are used wherever gauze bandages do not provide sufficient strength or support. They frequently are used to hold splints or bulky compression dressings in place. The length of the base is approximately 54 inches. These bandages were brought into prominence by Esmarch and still bear his name.
They are used in first-aid work for head dressings, binders, and arm slings and as temporary splints for broken bones.
Plaster of Paris? More recently introduced are synthetic cast materials made of polyester cotton or fiberglass. Various types of plastic sheets also are offered that can be shaped easily and hardened to a rigid form by cooling or chemical reaction. These are useful chiefly for splints and corrective braces. Individually packaged plaster of Paris bandages and splints are available in a wide variety of sizes.
The Specialist brand Johnson and Johnson is made from specially treated plaster, uniformly spread and firmly bonded to the fabric. This results in a high strength-to-weight ratio in casts made from such bandages. Synthetic casts are applied like plaster of Paris. The Delta-Lite Synthetic Casting System Johnson and Johnson offers both polyester, cotton fabric impregnated with a polyurethane resin, and fiberglass casting materials.
Scotchcast Softcast 3M consists of a knitted fiberglass substrate impregnated with a polyurethane resin containing a surface modifying agent reduce tack, facilitate application.
The casts are water-resistant, light weight, and durable. Stockinette Bandages are made of stockinette material knitted or woven in tubular form without seams.
Surgical stockinette is unbleached. Because it is soft and will stretch readily to conform comfortably to the arm, leg, or body, it is used to cover the skin prior to the application of a plaster of Paris or synthetic cast. They are composed of various fiber constructions that conform and cling, absorb moisture, and allow the skin to breathe. Surgical adhesive tapes are made in many different forms, varying both in the type of backing and in the formulation of the adhesive mass according to specific needs and requirements.
The tapes available today may be divided into two broad categories: those with a rubber-based adhesive and those with an acrylate adhesive. Both types have a variety of uses. When strength of backing, superior adhesion, and economy are required eg, athletic strapping , rubber adhesives commonly are used. Acrylate adhesives on a variety of backing materials are used widely in surgical dressing applications, when reduced skin trauma is required, as in operative and postoperative procedures; they are supplied in various strength and adhesion levels.
Because acrylate adhesives are basically a uni-polymeric system, they eliminate the use of a large number of components in rubber-based adhesives. In poly alkyl-acrylate adhesives, the desired balance between adhesion, cohesion, and flow properties is determined by the choice of monomers and the control of the polymerization reactions. Once the polymer is made, no other formulating or compounding is needed.
In addition, the acrylics have an excellent shelf-life because they are not affected readily by heat, light, or air, factors that tend to degrade rubber-based adhesives. Acrylate adhesives combine the proper balance of tack and long-term adhesion.
Their molecular structure permits the passage of water vapor so they are nonocclusive and thus when coated on a porous backing material do not cause overhydration in the stratum corneum. Traumatic response to surgical tapes is minimized substantially when tapes are constructed to allow normal skin moisture to pass through adhesive and backing material.
With this construction, the moisture content and strength of the horny cell layers remain relatively normal. When a porous tape is removed, the planes of separation develop near the surface of the stratum corneum, in the region of the naturally desquamating cells. This allows repeated use of tape over the same site with minimal damage to the skin.
Hypoallergenic Surgical Tapes with acrylate adhesive are available with a variety of porous backing materials. Rayon taffeta cloth backing provides a high-strength tape well-suited for affixing heavy dressings. Lighter dressing applications can be accomplished with lower-strength, economical, paperbacked surgical tapes. A knitted backing tape Dermiform, Johnson and Johnson provides some of the economies of paper surgical tape with the strength and conformability of a cloth backing.
Other tapes feature elastic cloth or foam backing materials for special taping needs. These are used principally where heavy support and a high level of adhesion are required.
Modern rubber-based adhesive tape masses consist of varying mixtures of several classes of substances and are composed of an elastomer para or pale crepe rubber in the case of natural rubber tapes, and synthetic elastomers made from polymers of isobutylene, alkyl-acrylate, or similar materials , one of several types of rosin or modified rosin, antioxidants, plasticizers and fillers, and coloring agents to give the tape the desired tint or whiteness.
Because adhesive tape masses historically have consisted of heterogeneous and complex mixtures of organic compounds, it is not surprising that many workers have ascribed adhesive tape reaction to allergy. More-recent work, however, has shown that a true allergic response to the modern adhesive tape mass or its components is a factor in only a small proportion of clinical reactions and that most observed reactions are ascribed properly to other factors, mainly mechanical irritation and, to a lesser degree, chemical irritation.
There apparently is no significant difference in reaction between patients with or without a history of allergy, but true specific dermatitis may occur more readily in persons who have manifested some other form of contact dermatitis.
Adverse manifestations produced by adhesive tape are characterized by erythema, edema, papules, vesicles, and in severe cases, desquamation. Itching may be intense, or it may be absent.
The reaction may be demonstrated readily by patchtesting, and usually manifests itself early-within 24 to 48 hr. Characteristically, the reaction becomes more severe the longer the tape is left in place and continues to increase in intensity for some time after the tape is removed. This type of reaction is long-lasting and requires days for its complete subsidence. Two distinct types of irritation can result from the mechanical dynamics of removing tape from the skin.
One response-induced vasodilation-is a relatively nontraumatic, transitory effect in which no actual damage to the skin occurs.
A second type-skin stripping-is a traumatic response in which skin is removed with the tape and actual damage to the epidermal layers results. Such mechanical skin removal is possibly the dominant cause of clinical reactions seen with the use of adhesive tape.
Chemical irritation from adhesive tape results when irritating components in the mass or backing of the tape permeate the underlying tissues of the skin. The tape construction can influence the reactivity of such ingredients substantially. For example, many compounds that normally do not penetrate intact stratum corneum can penetrate overhydrated corneum. When portions of the stratum corneum are removed, the barrier capacity of the skin is damaged substantially.
In this situation, any irritating components of the tape have ready access to underlying tissues. These substances then can cause a degree of irritation that is far greater than would be observed on intact skin. Until recently, protectives included only the various impermeable materials intended to be used adjunctively with other dressing components to prevent the loss of moisture or heat from a wound site or to protect clothing or bed liners from wound exudate.
Film dressings are excellent devices to protect against infection and dislodgement of vascular cannulae and drainage sites. In addition, they may be used to protect vulnerable areas against pressure sores. Protectives also are employed to cover wet dressings and hot or cold compresses.
In common use as protectives are plastic sheeting and waxed or plastic-coated paper. These prevent the escape of moisture or heat from the dressing or the compress and protect clothing or bed linens. Rubber sheeting is a rubber-coated cloth, waterproof and flexible, in various lengths and widths for use as a covering for bedding. A so-called nursery sheeting is supplied, coated only on one side. Adhesions are abnormal connections between organs or tissues that form after trauma, including surgery.
They consist of organized fibrin and fibrovascular scar tissue and complicate all areas of surgery. A total of operations were performed in patients; only five patients received any type of surgical bandaging.
There were four SSIs 0. The postoperative infection rate in the clean cases was 0. The data obtained in this investigation is consistent with the position that bandaging incisional scalp wounds after cranial surgery adds little if any benefit beyond the easier, simpler, and cheaper practice of using antibiotic ointment as a dressing without bandaging.
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