Prof. Kuester (Centralblatt f. Chirurgue, March 17, 1888,) in reply to
remarks made by Dr. Sonnenberg before the Association of Berlin
Surgeons, January 9, who characterized K’s method of treating the wound
after the operation for the radical cure of hernia as an “open method,”
objects to this designation of his method, and takes occasion to more
fully describe his method as follows: After the reduction of the
contents of the sac, the latter is sutured and excised, and the ring is
also closed by suturing. The wound cavity itself is now closed by
several rows of buried sutures, so arranged as to bring together the
edges of the several layers, tissue to like tissue. In congenital cases
he does not loosen the sac, but sutures its opposing surfaces down to
the point where the testicle lies free. The wound of the skin is now
closed by a continuous silk suture, and an iodoform and collodion
mixture brushed over the line of suturing until it is perfectly covered
in and blood no longer oozes through. No drain is used, and no further
dressing is deemed necessary. If, after two or three days, a split
occurs in the scab or crust formed by the drying of the iodoform and
collodion, the gap is quickly filled by a slight oozing from the deeper
portions of the wound, which, upon drying, becomes a bar against
infection.
There can be no doubt, if thorough asepsis is observed and obtained
during the operation, the method of completely obliterating every space
in which blood clot or serum could accumulate would do away with the
necessity for drainage. This granted, it follows, as a natural sequence,
that absorbent dressings are superfluous, simple protection of the line
of suturing from atmospheric influences, infection, etc., being alone
indicated. The iodoform and collodion compound would seem to fulfil this
admirably. The method could scarcely find application in large or deep
wounds, particularly if the latter invaded planes of dense connective
tissue, fasciæ, etc. Here it would be manifestly best to provide
drainage, etc.
In marked contrast to K’s method is that of McBurney, who, providing
against infiltration by suturing the entire thickness of each edge of
the wound together in such a manner as to render it practically but one
layer, packs the wound cavity, and thus obliterates the inguinal canal,
the latter filling up by granulation, a firm cicatricial plug taking its
place.