The Secrets of Specialists/Chapter 14

The above caption may appear as an exaggeration or perhaps a prevarication of facts regarding modern surgical methods; yet these means of operating may be accomplished. or nearly perfected by adopting the following procedures:

It is not only a great advantage to the surgeon, while operating, to cause the loss of as little blood as possible, for this continuous oozing of blood is a source of annoyance during operative procedure, but it is also an advantage to the patient; not that the loss of blood will always be great, but many patients would withstand operations much better if it were not for the sight of blood. It is, therefore, always best to have all operations as devoid of blood as possible. When the operative field is upon the extremities, we have absolute control of bleeding by the use of an Esmarch Hæmostatic Bandage, but when we have the flat surface of the balance of the body, it is a different proposition. We do, however, have a decided control of hemorrhage, on superficial surfaces, by the use of adrenaline solutions of various strength; these solutions may be incorporated with the selected local anesthetic or used independently as desired. The adrenalin, added to, or used in conjunction with, cocaine, novocain or quinine and urea hydrochloride, adds to the anesthetic value, in making the anasthesia more profound, and also avoids the depressive effects of the anesthetic, as adrenaline is a pronounced heart ​stimulant. My experience has convinced me that the addition of adrenaline chloride, in the solution of 1:1,000 to 1:20,0000 has a distinct value in all minor operative surgery.

The strength of the adrenalin solution will depend upon the size of the surface to be operated upon; the smaller the surface, the stronger the solution. As a rule I frequently add to the three per cent. cocaine solution, given in the preceding chapter, three to five minims to a syringeful of a 1:1,000 adrenalin solution, and the results are most satisfactory; however, if larger surfaces are anæsthetized, I alternate the injection of quinine and urca hydrochloride with an adrenalin solution, from 1:2,000 or even 1:5,000, and obtain equal results.

With a view of uniting cutaneous surfaces to avoid the formation of as little cicatricial tissue as possible, has introduced into surgery a new method of uniting wounds, without the use of sutures. Every surgeon is familiar with the fact that the penetration and tension of ordinary sutures are followed by minute indentures, which are filled with cicatricial tissue, after the removal of the suture, and to avoid these unsightly stitch holes, which are often more objectionable to the patient than the line of incision itself, wound clips are used. These clips are made of solid silver, which may be thoroughly sterilized by boiling, and offer many advantages over the ordinary sutures, viz.:

If care is exercised, they will unite wounds with the greatest degree of accuracy in the apposition of the entaneous edges, and thus reduce the formation of resulting scar, since there are none of the cross marks made by the thread passing from one needle hole to another, and no perceptible trace of their contact with the skin, as they do not puncture the cuticle deep enough to leave a scar. They are much more easily and quickly applied, as the four fangs of each clip will accomplish the results of two stitches in one-half the time it ​takes to use the older method. Also, they leave a flat surface, thus facilitating the application of bandages and dressings. Perfect asepsis is assured, since germs find no opportunity of following the suture tract into the depths, and therefore, there is no oozing around stitches, which are invariably filled with cicatricial tissue after operations. The application of these clips is practically painless, and never requires an anesthetic to close a wound.

Surgeons, like all other fine mechanics, endeavor to have their work appear as if it were accomplished by a master hand; and in manipulating the human mechanism, to unite eutaneous surfaces, has given them an opportunity of displaying their skill; therefore, the scarless surgeon is in as great demand as the painless operator.

This method of reducing scar tissue to the minimum is said to have originated with a Japanese surgeon. The usual way of incising the skin has always been at a right angle, but ​such incisions are always followed by a lineal scar, which is difficult to entirely obliterate; but, making the incision in a slanting position (see illustration) at an angle of about forty-five or more degrees, will give a better contact, and although the process of healing is the same, the fibrous and scar tissues is hidden from observation. If this method is carefully conducted, the resultant cicatricial tissue is reduced to a minimum. This is always the method used upon the face and other parts of the body, where scar tissue is objectionable. Of course it is impossible to entirely avoid the formation of some scar tissue, but after reducing its formation, by this means, to the smallest possible amount, the balance may generally be obliterated, after healing, by what is known as the blending process. This consists of pinching a fold of skin, containing the scar, between the thumb and finger until the skin is tense and rubbing the scar violently, almost to the point of drawing blood, with the forefinger of the other hand, using any suitable massage cream for the purpose. This keeps the skin somewhat irritated, and by repeating the treatment a number of times, the scar tissue will gradually fade away, although it may take several weeks or months to accomplish the desired results. You may also use Thiosinamin by Cataphoresis as described on another page.

In order that I may illustrate the success obtained by the foregoing methods I will cite the following case: Mr. H. —— applied to me to have a lipoma removed on his neck, directly back of the ear. This tumor had been developing for about ​two years and had obtained about the size of a small hen's egg. I injected the surrounding tissue with the following solution:

This solution was injected along the median line of the incision, and at several points around the tumor until the pricking of the knife would cause no pain. The two central incisions were made at an angle of about 45 degrees in the same direction, leaving about one-half inch space of skin in the center intact, so that when uniting the wound there would be no superfluous skin. The tumor was now carefully dissected away without rupturing the sac and the edges of the cutaneous surface placed in as close apposition as possible, and united with the wound clips. The operative procedure and final results were almost perfect. The patient did not complain of any pain during the operation. The adrenalin solution reduced the hemorrhage to the minimum. The skin healed with only a trace of cicatricial tissue and there was absolutely no trace of scar tissue where the wound clips had been applied, and represent surgery in what I consider its most perfected form.