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A new and effective anorectal dressing
A NEW AND EFFECTIVE ANORECTAL DRESSING* CECIL D. GASTON,
M.D.,
F.A.c.s.,
P.A.P.S.
AND HOWARD
B.
WILLIAMS,
M.D.
Late Chief of Proctology, South Highlands Infirmary and HiIIman HospitaI BIRMINGHAM, OLLOWING anorecta1 operations bacteria-Iaden moisture continuousIy bathes the operative heId: This irritating excretion promotes profuse granmation, retards expithehzation, induces painfu1 wounds, creates a sense of uncIeanIiness, excites pruritus ani, sIows the process of healing, and Ieads to the deveIopment of a tough, deforming and sensitive scar. Postoperative dressing with an ointment or powder markedIy increases this moisture. It occurred to us to seek an analgesic, astringent, germicida1 and muciIaginous dressing. The Iatter property causes proIonged contact with the tissues. FoIIowing experimentation with many agents, we seIected a mixture of 3 per cent gentian vioIet, IO per cent tannic acid and I per cent pontocaine in a heavy muciIage of acacia. To prevent the formation of crystaIs and smaI1 Iumps, this mixture must be painstakingIy compounded. A thick and smooth muciIage is essential. The folIowing plan for preparation of 500 C.C. of the mixture is recommended: DissoIve 5 Gm. (50 tabIets, each gr. 145) of pontocaine in 4 ounces of distiIIed water. Add 50 Gm. of tannic acid and stir unti1 dissoIved. Add 15 Gm. of gentian vioIet crystaIs and stir unti1 a soIution is effected. Strain through gauze into a Iarge mortar. Add sIowIy, whiIe agitating vigorousIy; sufficient acacia to make a thick paste. This requires approximateIy 250 Gm. of acacia. Now add graduaIIy, stirring continuousIy, distiIIed water to make 500 C.C.Let the mixture stand in mortar twentyfour hours, stirring every three or four hours if possibIe. At the end of this time agitate vigorousIy with pestIe, then force the thick muciIage through two Iayers of gauze with
F
ALABAMA
the aid of a spatuIa. This mixture remains stabIe when kept tightIy corked. During the first thirty-six hours foIIowing compIetion of the dressing, a Iight foam may form on its surface, precipitating a thin Iayer of acacia. The acacia wiI1 return into soIution if stirred. To faciIitate its appIication on the gIoved finger or on an appIicator this dressing shouId be dispensed in a wide-mouthed container. A properIy made mixture spreads on the skin as a smooth and homogeneous mucilage, drying quickIy to remain as a purpIe paint. When an operation is concIuded, we appIy the dressing generousIy to a11 wounds: circumana1, anal and rectaI. SubsequentIy the operative field is dried after each sitzbath and an attendant then appIies the dressing to the circumana1 wounds. During the first postoperative week the dressing is applied twice daiIy to the wounds within the ana canal and rectum by means of a smaI1, soft, mop-Iike appIicator. Thereafter, its appIication within the cana is made once daiIy by us and to the circumana1 wounds by the patient or an attendant after each sitz-bath. We have empIoyed this dressing routineIy and with uniform resuIts since Janare: uary, 1938. Its proved advantages (I) absence of postoperative oozing; (2) marked contro1 of postoperative hyperesthesia, pain, edema and pruritus ani; (3) a miId tanning of the tissues with continuous dryness of the fieId; (4) absence of exuberant granuIation. This tissue remains firm and IeveI with the skin, presenting a heaIthy pink appearance without a tendency to bIeed, and (5) rapid healing with resuItant thin and ffexibIe scars.
* Read before American ProctoIogic Society, Brooklyn, New York, June 329
25-27,
1939.
M.D.,
F.A.c.s.,
P.A.P.S.
AND HOWARD
B.
WILLIAMS,
M.D.
Late Chief of Proctology, South Highlands Infirmary and HiIIman HospitaI BIRMINGHAM, OLLOWING anorecta1 operations bacteria-Iaden moisture continuousIy bathes the operative heId: This irritating excretion promotes profuse granmation, retards expithehzation, induces painfu1 wounds, creates a sense of uncIeanIiness, excites pruritus ani, sIows the process of healing, and Ieads to the deveIopment of a tough, deforming and sensitive scar. Postoperative dressing with an ointment or powder markedIy increases this moisture. It occurred to us to seek an analgesic, astringent, germicida1 and muciIaginous dressing. The Iatter property causes proIonged contact with the tissues. FoIIowing experimentation with many agents, we seIected a mixture of 3 per cent gentian vioIet, IO per cent tannic acid and I per cent pontocaine in a heavy muciIage of acacia. To prevent the formation of crystaIs and smaI1 Iumps, this mixture must be painstakingIy compounded. A thick and smooth muciIage is essential. The folIowing plan for preparation of 500 C.C. of the mixture is recommended: DissoIve 5 Gm. (50 tabIets, each gr. 145) of pontocaine in 4 ounces of distiIIed water. Add 50 Gm. of tannic acid and stir unti1 dissoIved. Add 15 Gm. of gentian vioIet crystaIs and stir unti1 a soIution is effected. Strain through gauze into a Iarge mortar. Add sIowIy, whiIe agitating vigorousIy; sufficient acacia to make a thick paste. This requires approximateIy 250 Gm. of acacia. Now add graduaIIy, stirring continuousIy, distiIIed water to make 500 C.C.Let the mixture stand in mortar twentyfour hours, stirring every three or four hours if possibIe. At the end of this time agitate vigorousIy with pestIe, then force the thick muciIage through two Iayers of gauze with
F
ALABAMA
the aid of a spatuIa. This mixture remains stabIe when kept tightIy corked. During the first thirty-six hours foIIowing compIetion of the dressing, a Iight foam may form on its surface, precipitating a thin Iayer of acacia. The acacia wiI1 return into soIution if stirred. To faciIitate its appIication on the gIoved finger or on an appIicator this dressing shouId be dispensed in a wide-mouthed container. A properIy made mixture spreads on the skin as a smooth and homogeneous mucilage, drying quickIy to remain as a purpIe paint. When an operation is concIuded, we appIy the dressing generousIy to a11 wounds: circumana1, anal and rectaI. SubsequentIy the operative field is dried after each sitzbath and an attendant then appIies the dressing to the circumana1 wounds. During the first postoperative week the dressing is applied twice daiIy to the wounds within the ana canal and rectum by means of a smaI1, soft, mop-Iike appIicator. Thereafter, its appIication within the cana is made once daiIy by us and to the circumana1 wounds by the patient or an attendant after each sitz-bath. We have empIoyed this dressing routineIy and with uniform resuIts since Janare: uary, 1938. Its proved advantages (I) absence of postoperative oozing; (2) marked contro1 of postoperative hyperesthesia, pain, edema and pruritus ani; (3) a miId tanning of the tissues with continuous dryness of the fieId; (4) absence of exuberant granuIation. This tissue remains firm and IeveI with the skin, presenting a heaIthy pink appearance without a tendency to bIeed, and (5) rapid healing with resuItant thin and ffexibIe scars.
* Read before American ProctoIogic Society, Brooklyn, New York, June 329
25-27,
1939.