The first doctor applied a plaster cast. Who came up with the idea of using plaster to fix fractures and speed up their healing? Indications and contraindications
"Divine art to destroy pain" for a long time was beyond the control of man. For centuries, patients have been forced to patiently endure torment, and healers have not been able to end their suffering. In the 19th century, science was finally able to conquer pain.
Modern surgery uses for and A who first invented anesthesia? You will learn about this in the process of reading the article.
Anesthesia techniques in antiquity
Who invented anesthesia and why? Since the birth of medical science, doctors have been trying to solve an important problem: how to make surgical procedures as painless as possible for patients? With severe injuries, people died not only from the consequences of the injury, but also from the experienced pain shock. The surgeon had no more than 5 minutes to perform the operations, otherwise the pain became unbearable. The Aesculapius of antiquity were armed with various means.
In ancient Egypt, crocodile fat or alligator skin powder was used as an anesthetic. One of the ancient Egyptian manuscripts, dated 1500 BC, describes the analgesic properties of the opium poppy.
In ancient India, doctors used substances based on Indian hemp to obtain painkillers. Chinese physician Hua Tuo, who lived in the 2nd century BC. AD, offered patients to drink wine with the addition of marijuana before the operation.
Anesthesia methods in the Middle Ages
Who invented anesthesia? In the Middle Ages, the miraculous effect was attributed to the root of the mandrake. This plant from the nightshade family contains potent psychoactive alkaloids. Drugs with the addition of an extract from the mandrake had a narcotic effect on a person, clouded the mind, dulled the pain. However, the wrong dosage could lead to death, and frequent use caused drug addiction. The analgesic properties of mandrake for the first time in the 1st century AD. described by the ancient Greek philosopher Dioscorides. He gave them the name "anesthesia" - "without feeling."
In 1540, Paracelsus proposed the use of diethyl ether for pain relief. He repeatedly tried the substance in practice - the results looked encouraging. Other doctors did not support the innovation, and after the death of the inventor, this method was forgotten.
To turn off a person's consciousness for the most complex manipulations, surgeons used a wooden hammer. The patient was struck on the head, and he temporarily fell into unconsciousness. The method was crude and inefficient.
The most common method of medieval anesthesiology was ligatura fortis, i.e., infringement of nerve endings. The measure allowed to slightly reduce pain. One of the apologists for this practice was Ambroise Pare, the court physician of the French monarchs.
Cooling and hypnosis as methods of pain relief
At the turn of the 16th and 17th centuries, the Neapolitan physician Aurelio Saverina reduced the sensitivity of operated organs with the help of cooling. The diseased part of the body was rubbed with snow, thus being subjected to a slight frost. Patients experienced less pain. This method has been described in the literature, but few people have resorted to it.
About anesthesia with the help of cold was remembered during the Napoleonic invasion of Russia. In the winter of 1812, the French surgeon Larrey carried out mass amputations of frostbitten limbs right on the street at a temperature of -20 ... -29 ° C.
In the 19th century, during the mesmerization craze, attempts were made to hypnotize patients before surgery. BUT when and who invented anesthesia? We will talk about this further.
Chemical experiments of the XVIII-XIX centuries
With the development of scientific knowledge, scientists began to gradually approach the solution of a complex problem. At the beginning of the 19th century, the English naturalist H. Davy established on the basis of personal experience that the inhalation of nitrous oxide vapors dulls the sensation of pain in a person. M. Faraday found that a similar effect is caused by a pair of sulfuric ether. Their discoveries have not found practical application.
In the mid 40s. XIX century dentist G. Wells from the USA became the first person in the world who underwent surgical manipulation while under the influence of an anesthetic - nitrous oxide or "laughing gas". Wells had a tooth removed, but he felt no pain. Wells was inspired by a successful experience and began to promote new method. However, a repeated public demonstration of the action of a chemical anesthetic ended in failure. Wells failed to win the laurels of the discoverer of anesthesia.
The invention of ether anesthesia
W. Morton, who practiced in the field of dentistry, became interested in the study of the analgesic effect. He carried out a series of successful experiments on himself and on October 16, 1846, he immersed the first patient in a state of anesthesia. An operation was performed to painlessly remove the tumor on the neck. The event received a wide response. Morton patented his innovation. He is officially considered the inventor of anesthesia and the first anesthesiologist in the history of medicine.
In medical circles, they picked up the idea ether anesthesia. Operations with its use were made by doctors in France, Great Britain, Germany.
Who invented anesthesia in Russia? The first Russian doctor who dared to test the advanced method on his patients was Fedor Ivanovich Inozemtsev. In 1847, he performed several complex abdominal operations on patients immersed in it. Therefore, he is the discoverer of anesthesia in Russia.
The contribution of N. I. Pirogov to the world anesthesiology and traumatology
Other Russian doctors followed in the footsteps of Inozemtsev, including Nikolai Ivanovich Pirogov. He not only operated on patients, but also studied the effects of ethereal gas, tried different ways its introduction into the body. Pirogov summarized and published his observations. He was the first to describe the techniques of endotracheal, intravenous, spinal and rectal anesthesia. His contribution to the development of modern anesthesiology is invaluable.
Pirogov is the one. For the first time in Russia, he began to fix injured limbs with a plaster cast. The physician tested his method on wounded soldiers during the Crimean War. However, Pirogov cannot be considered the discoverer of this method. Gypsum as a fixing material was used long before him (Arab doctors, the Dutch Hendrichs and Mathyssen, the Frenchman Lafargue, the Russians Gibental and Basov). Pirogov only improved plaster fixation, made it light and mobile.
Discovery of chloroform anesthesia
In the early 30s. Chloroform was discovered in the 19th century.
A new type of anesthesia using chloroform was officially presented to the medical community on November 10, 1847. Its inventor, the Scottish obstetrician D. Simpson, actively introduced anesthesia for women in labor to facilitate the process of childbirth. There is a legend that the first girl who was born painlessly was given the name Anasthesia. Simpson is rightfully considered the founder of obstetric anesthesiology.
Chloroform anesthesia was much more convenient and profitable than ether anesthesia. He quickly plunged a person into sleep, had a deeper effect. He did not need additional equipment, it was enough to inhale the vapors with gauze soaked in chloroform.
Cocaine - local anesthetic of South American Indians
Ancestors local anesthesia considered to be South American Indians. They have been practicing cocaine as an anesthetic since ancient times. This plant alkaloid was extracted from the leaves of the local shrub Erythroxylon coca.
The Indians considered the plant a gift from the gods. Coca was planted in special fields. Young leaves were carefully cut off from the bush and dried. If necessary, the dried leaves were chewed and saliva was poured over the damaged area. It lost sensitivity, and traditional healers proceeded to the operation.
Koller's research in local anesthesia
The need to provide anesthesia in a limited area was especially acute for dentists. Extraction of teeth and other interventions in dental tissues caused unbearable pain in patients. Who Invented Local Anesthesia? In the 19th century, in parallel with experiments on general anesthesia searches were made effective method for limited (local) anesthesia. In 1894, a hollow needle was invented. To stop toothache, dentists used morphine and cocaine.
Vasily Konstantinovich Anrep, a professor from St. Petersburg, wrote about the properties of coca derivatives to reduce sensitivity in tissues. His works were studied in detail by the Austrian ophthalmologist Karl Koller. The young doctor decided to use cocaine as an anesthetic for eye surgery. The experiments were successful. Patients remained conscious and did not feel pain. In 1884, Koller informed the Viennese medical community of his achievements. Thus, the results of the experiments of the Austrian doctor are the first officially confirmed examples of local anesthesia.
The history of the development of endotrachial anesthesia
In modern anesthesiology, endotracheal anesthesia, also called intubation or combined anesthesia, is most often practiced. This is the safest type of anesthesia for a person. Its use allows you to control the patient's condition, to carry out complex abdominal operations.
Who invented endotrochial anesthesia? The first documented case of the use of a breathing tube in medical purposes associated with Paracelsus. An outstanding doctor of the Middle Ages inserted a tube into the trachea of a dying person and thereby saved his life.
André Vesalius, a professor of medicine from Padua, conducted experiments on animals in the 16th century by inserting breathing tubes into their tracheas.
The occasional use of breathing tubes during operations provided the basis for further development in the field of anesthesiology. In the early 70s of the XIX century, the German surgeon Trendelenburg made a breathing tube equipped with a cuff.
The use of muscle relaxants in intubation anesthesia
Mass use of intubation anesthesia began in 1942, when Canadians Harold Griffith and Enid Johnson used muscle relaxants during surgery - drugs that relax muscles. They injected the patient with the alkaloid tubocurarine (intokostrin), obtained from the well-known poison of the South American curare Indians. The innovation facilitated the implementation of intubation measures and made operations safer. Canadians are considered to be the innovators of endotracheal anesthesia.
Now you know who invented general and local anesthesia. Modern anesthesiology does not stand still. Successfully applied traditional methods introducing the latest medical developments. Anesthesia is a complex, multicomponent process on which the health and life of the patient depends.
So, today we have Saturday, April 1, 2017, and again in the studio with Dmitry Dibrov, star guests. The questions are the easiest at first, but with each task they become more difficult, and the amount of winnings grows, so let's play together, don't miss it. And we have a question - Which doctor was the first in the history of Russian medicine to use plaster?
- A. Subbotin
- B. Pirogov
- C. Botkin
- D. Sklifosovsky
The correct answer is B - PIROGOV
The invention and widespread introduction into medical practice of a plaster cast for bone fractures is one of the most important achievements of surgery in the last century. And it was N.I. Pirogov was the first in the world to develop and put into practice a fundamentally new method of dressing impregnated with liquid gypsum.
It cannot be said that before Pirogov there were no attempts to use gypsum. Known are the works of Arab doctors, the Dutchman Hendrichs, Russian surgeons K. Gibental and V. Basov, a surgeon from Brussels Seten, a Frenchman Lafargue and others. However, they did not use a bandage, but a solution of gypsum, sometimes mixing it with starch, adding blotting paper to it.
An example of this is the Basov method proposed in 1842. The broken arm or leg of the patient was placed in a special box filled with alabaster solution; the box was then attached to the ceiling through a block. The victim was essentially bedridden.
In 1851, the Dutch doctor Mathyssen had already begun to use plaster cast. He rubbed strips of cloth with dry gypsum, wrapped them around the injured limb, and only then wetted them with water.
To achieve this, Pirogov tries to use various raw materials for dressings - starch, gutta-percha, colloidin. Convinced of the shortcomings of these materials, N.I. Pirogov proposed his own plaster cast, which is used almost unchanged at the present time.
One of the most important inventions of a brilliant Russian doctor, who was the first to use anesthesia on the battlefield and brought nurses into the army
Imagine an ordinary emergency room - say, somewhere in Moscow. Imagine that you are there not for personal need, that is, not with an injury that distracts you from any extraneous observations, but as a bystander. But - with the ability to look into any office. And now, passing along the corridor, you notice a door with the inscription "Plaster". What about her? Behind her - classic medical office, whose appearance differs only in a low square bath in one of the corners.
Yes, yes, this is the very place where a plaster cast will be applied to a broken arm or leg, after an initial examination by a traumatologist and an x-ray. What for? So that the bones grow together as they should, and not as horrible. And so that the skin can still breathe. And so as not to disturb a broken limb with a careless movement. And ... What is there to ask! After all, everyone knows: once something is broken, it is necessary to apply plaster.
But this “everyone knows” is at most 160 years old. Because for the first time a plaster cast as a means of treatment was used in 1852 by the great Russian doctor, surgeon Nikolai Pirogov. Before him, no one in the world had done this. Well, after it, it turns out, anyone can do it, anywhere. But the “Pirogovskaya” plaster cast is just the priority that no one in the world disputes. Simply because it is impossible to dispute the obvious: the fact that gypsum is medical device- one of the purely Russian inventions.
Portrait of Nikolai Pirogov by artist Ilya Repin, 1881.
War as an engine of progress
By the beginning of the Crimean War, Russia was largely unprepared. No, not in the sense that she did not know about the impending attack, like the USSR in June 1941. In those distant times, the habit of saying “I’m going to attack you” was still in use, and intelligence and counterintelligence were not yet so developed as to carefully hide the preparation for an attack. The country was not ready in the general, economic and social sense. Lacked modern weapons, modern fleet, railways(and it turned out to be critical!) leading to the theater of operations…
And there were not enough doctors in the Russian army. By the beginning of the Crimean War, the organization of the medical service in the army was in accordance with the guidelines written a quarter of a century before. According to his requirements, after the outbreak of hostilities, the troops should have had more than 2,000 doctors, almost 3,500 paramedics and 350 paramedic students. In reality, there was not enough of anyone: neither doctors (a tenth part), nor paramedics (twentieth part), and there were no students at all.
It would seem that not such a significant shortage. But nevertheless, as the military researcher Ivan Bliokh wrote, “at the beginning of the siege of Sevastopol, one doctor accounted for three hundred wounded people.” To change this ratio, according to the historian Nikolai Gubbenet, more than a thousand doctors were recruited during the Crimean War, including foreigners and students who received a diploma but did not complete their studies. And almost 4,000 paramedics and their students, half of whom failed during the fighting.
In such a situation, and taking into account, alas, the rear organized disorder characteristic of the Russian army of that time, the number of wounded who were permanently disabled should have reached at least a quarter. But just as the resilience of the defenders of Sevastopol amazed the allies preparing for a quick victory, so the efforts of the doctors unexpectedly gave a much better result. The result, which had several explanations, but one name - Pirogov. After all, it was he who introduced immobilizing plaster bandages into the practice of military field surgery.
What did it give the army? First of all, the ability to return to service many of those wounded who, a few years earlier, would have simply lost an arm or leg as a result of amputation. After all, before Pirogov, this process was arranged very simply. If a person with a broken bullet or a fragment of an arm or leg got on the table of surgeons, he was most often expected to be amputated. Soldiers - by the decision of doctors, officers - by the results of negotiations with doctors. Otherwise, the wounded still most likely would not have returned to duty. After all, unfixed bones grew together at random, and the person remained a cripple.
From workshop to operating room
As Nikolai Pirogov himself wrote, "war is a traumatic epidemic." And as for any epidemic, for the war there had to be some kind of vaccine, figuratively speaking. She - in part, because not all wounds are exhausted by broken bones - and gypsum became.
As is often the case with ingenious inventions, Dr. Pirogov came up with the idea of making his immobilizing bandage literally from what lies under his feet. Or rather, under the arms. Since the final decision to use gypsum for dressing, moistened with water and fixed with a bandage, came to him in ... the sculptor's workshop.
In 1852, Nikolai Pirogov, as he himself recalled a decade and a half later, watched the work of the sculptor Nikolai Stepanov. “For the first time I saw ... the effect of a plaster solution on the canvas,” the doctor wrote. - I guessed that it could be used in surgery, and immediately put bandages and strips of canvas soaked in this solution on a complex fracture of the lower leg. The success was wonderful. The bandage dried up in a few minutes: an oblique fracture with a strong blood stain and perforation of the skin ... healed without suppuration and without any seizures. I am convinced that this bandage can find great application in field practice. As, in fact, it happened.
But the discovery of Dr. Pirogov was the result of not only an accidental insight. Nikolai Ivanovich struggled over the problem of a reliable fixing bandage for more than a year. By 1852, behind Pirogov's back, there was already experience in using linden popular prints and a starch dressing. The latter was something very similar to a plaster cast. Pieces of canvas soaked in a starch solution were applied layer by layer to a broken limb - just like in the papier-mâché technique. The process was quite long, the starch did not solidify immediately, and the bandage turned out to be bulky, heavy and not waterproof. In addition, it did not allow air to pass through well, which negatively affected the wound if the fracture was open.
By the same time, ideas using plaster were already known. For example, in 1843, a thirty-year-old doctor, Vasily Basov, proposed fixing a broken leg or arm with alabaster, poured into a large box - a “dressing projectile”. Then this box on blocks was lifted to the ceiling and fixed in this position - almost in the same way as today, if necessary, cast limbs are fixed. But the weight was, of course, prohibitive, and breathability - no.
And in 1851, the Dutch military doctor Antonius Mathijsen put into practice his method of fixing broken bones with the help of bandages rubbed with plaster, which were applied to the fracture site and moistened with water right there. He wrote about this innovation in February 1852 in the Belgian medical journal Reportorium. So the idea in the full sense of the word was in the air. But only Pirogov was able to fully appreciate it and find the most convenient way of plastering. And not just anywhere, but in the war.
"Precautionary allowance" in Pirogov's way
Let's return to the besieged Sevastopol, during the Crimean War. The surgeon Nikolai Pirogov, already famous by that time, arrived at it on October 24, 1854, in the midst of events. It was on this day that the infamous Inkerman battle took place, which ended in a major failure for the Russian troops. And here the shortcomings of the organization of medical care in the troops showed themselves to the fullest.
Painting "The 20th Infantry Regiment at the Battle of Inkerman" by artist David Rowlands. Source: wikipedia.org
In a letter to his wife Alexandra on November 24, 1854, Pirogov wrote: “Yes, on October 24, the matter was not unexpected: it was foreseen, intended and not taken care of. 10 and even 11,000 were out of action, 6,000 were too wounded, and absolutely nothing was prepared for these wounded; like dogs, they were thrown on the ground, on the bunks, for whole weeks they were not bandaged and not even fed. The British were reproached after Alma for having done nothing in favor of the wounded enemy; we ourselves did nothing on October 24th. Arriving in Sevastopol on November 12, therefore, 18 days after the case, I found too 2000 wounded, crowded together, lying on dirty mattresses, mixed up, and for a whole 10 days, almost from morning to evening, I had to operate on those who were supposed to be operated on immediately after battles."
It was in this environment that the talents of Dr. Pirogov manifested themselves in full. Firstly, it was he who was credited with introducing the sorting system for the wounded into practice: “I was the first to introduce sorting of the wounded at Sevastopol dressing stations and thereby destroyed the chaos that prevailed there,” the great surgeon himself wrote about this. According to Pirogov, each wounded person had to be assigned to one of five types. The first is the hopeless and mortally wounded, who no longer need doctors, but comforters: nurses or priests. The second - seriously and dangerously wounded, requiring urgent assistance. The third is the seriously wounded, "who also require urgent, but more protective benefits." The fourth is "the wounded, for whom immediate surgical assistance is necessary only to make transportation possible." And finally, the fifth - "lightly wounded, or those in whom the first benefit is limited to applying a light dressing or removing a superficially sitting bullet."
And secondly, it was here, in Sevastopol, that Nikolai Ivanovich began to widely use the plaster cast he had just invented. How much importance he attached to this innovation may be judged by a simple fact. It was under him that Pirogov singled out a special type of wounded - requiring "precautionary benefits".
How widely the plaster cast was used in Sevastopol and, in general, in the Crimean War, can only be judged by indirect signs. Alas, even Pirogov, who meticulously described everything that happened to him in the Crimea, did not bother to leave to his descendants accurate information on this matter - mostly value judgments. Shortly before his death, in 1879, Pirogov wrote: “The plaster cast was first introduced by me into military hospital practice in 1852, and into military field practice in 1854, finally ... took its toll and became a necessary accessory of field surgical practice. I allow myself to think that my introduction of a plaster cast in field surgery, mainly contributed to the spread of savings treatment in field practice.
Here it is, that very “savings treatment”, it is also a “precautionary allowance”! It was for him that they used in Sevastopol, as Nikolai Pirogov called it, "a stuck-on alabaster (gypsum) bandage." And the frequency of its use directly depended on how many wounded the doctor tried to save from amputation - which means how many soldiers needed to put plaster on gunshot fractures of the arms and legs. And apparently they numbered in the hundreds. “We suddenly had up to six hundred wounded in one night, and we did too seventy amputations within twelve hours. These stories are repeated incessantly in various sizes,” Pirogov wrote to his wife on April 22, 1855. And according to eyewitnesses, the use of Pirogov's "stuck bandage" made it possible to reduce the number of amputations by several times. It turns out that only on that nightmarish day, about which the surgeon told his wife, gypsum was applied to two or three hundred wounded!
GYPSUM TECHNOLOGY- a series of sequential manipulations and techniques associated with the use of gypsum in medicinal purposes. The ability of moistened gypsum to take the given shape during hardening is used in surgery, traumatology and dentistry for fixing and immobilizing bone fragments, as well as for obtaining models of dentition, jaws and face masks. G. t. is used in the treatment of various diseases and injuries of the limbs and spine. For this purpose, various plaster bandages, corsets and cribs are used.
Story
Treatment of fractures by fixation of fragments with the help of various hardening agents has been carried out for a long time. So, even Arab doctors used clay to treat fractures. in Europe by the middle of the 19th century. hardening mixtures have been used camphor alcohol, lead water and whipped protein (D. Larrey, 1825), starch with gypsum [Lafarque (Lafarque), 1838]; starch, dextrin, wood glue were also used.
One of the first successful attempts to use gypsum for this purpose belongs to the Russian surgeon Karl Gibenthal (1811). He doused the injured limb with a solution of gypsum, first on one side, and then, lifting it up, on the other, and thus received. cast of two halves; then, without taking casts, he attached them to the limb with bandages. Later, Cloquet (J. Cloquet, 1816) suggested placing the limb in a bag of gypsum, which was then moistened with water, and V. A. Basov (1843) in a special box filled with alabaster.
Essentially, all of these methods did not use plaster casts, but plaster molds.
For the first time, dressings made of fabric, previously rubbed with dry plaster, began to be used for the treatment of fractures by the Dutch surgeon Mathysen (A. Mathysen, 1851). After applying a continuous bandage, it was moistened with a sponge. Later, Van de Loo (J. Van de Loo, 1853) improved this method by suggesting that the cloth rubbed with plaster should be moistened with water before bandaging. The Royal Academy of Medicine of Belgium recognized Mathijsen and Van de Loo as the authors of the plaster cast.
However, the invention of a plaster bandage - the prototype of the modern one, its widespread use for the treatment of patients with bone fractures belongs to N.I. Pirogov, who described it in a special brochure and book "Ghirurgische Hospitalklinik" in 1851-1852. The book published by Pirogov "A molded alabaster plaster bandage in the treatment of simple and complex fractures and for the transport of the wounded on the battlefield" (1854) is a work that summarizes the previous information about the methodology, indications and technique for using a plaster bandage. Pirogov believed that with the Mathijsen method, alabaster impregnates the canvas unevenly, does not hold tightly, easily breaks and crumbles. Pirogov's method was as follows: the limb was wrapped in rags, additional rags were placed on the bone protrusions; dry gypsum was poured into water and a solution was prepared; shirt sleeves, underpants or stockings were folded into 2-4 layers and lowered into solution, then stretched “on the fly”, smeared with hands on both sides of each strip. Stripes (longets) were applied to the injured limb and strengthened with transverse strips, superimposed so that one half covered the other. Thus, Pirogov, who first proposed the imposition of plaster bandages impregnated with liquid plaster, is the creator of both circular and longet plaster bandages. The propagandist and defender of the plaster cast was Professor of Derpt University Yu. K. Shimanovsky, who published in 1857 the monograph military surgery". Adelman and Shimanovsky proposed an unlined plaster cast (1854).
Over time, the technique of making plaster bandages has been improved. In modern conditions, factory-packed plaster bandages of certain sizes are mainly used (length - 3 m, width - 10, 15, 20 cm), less often - such bandages are made by hand.
Indications and contraindications
Indications. A plaster bandage is widely used for peacetime and wartime injuries and in the treatment of various diseases of the musculoskeletal system, when immobilization of the limb, trunk, neck, head is necessary (see Immobilization).
Contraindications: circulatory disorders due to ligation of large vessels, limb gangrene, anaerobic infection; purulent streaks, phlegmon. The imposition of G. p. is also inappropriate for persons old age with severe somatic disorders.
Equipment and tools
Plastering is usually carried out in specially designated rooms (gypsum room, dressing room). They are equipped with special equipment (tables for material preparation and plastering, basins, back and leg holders, a frame for hanging the patient when applying a corset bandage with a loop for traction, etc.), tools, basins for wetting bandages. To apply and remove a plaster cast, you must have the following tools (Fig. 1): scissors of various designs - straight, angled, button-shaped; gypsum expanders; forceps for bending the edge of the bandage; saws - semicircular, sheet, round.
Basic rules for applying plaster bandages
The patient is given a position, with Krom free access to the damaged part of the body is easily achieved. Bone protrusions and parts of the body at the edge of the bandage are covered with cotton wool to avoid bedsores. When casting, it is necessary to comply with the requirement for a certain arrangement of personnel: the surgeon holds the limb in the correct position, and the assistant or plaster technician applies a bandage. It is necessary to strictly observe the rules of bandaging. The first tours of the bandage, covering the area intended for gypsum, are not applied tightly, the subsequent ones are more dense; the bandage is led spirally with moderate tension, applying each subsequent move to 1/3-1/2 of the surface of the previous one; the bandage is constantly smoothed to avoid the formation of constrictions, kinks and depressions. To ensure a uniform fit of the bandage to the body, after applying the third layer, modeling of the bandage is started, compressing the bandage according to the contours of the body. The bandage should have a uniform number of plaster layers (6-12), be somewhat thicker in places subject to fracture (in the area of the joint, at fracture sites); as a rule, it should capture two adjacent joints.
After applying a bandage, the limb must be elevated to reduce swelling; for this, metal tires, pillows, a functional bed are used. Beds for patients with hip bandages and corsets should be equipped with shields. A properly applied plaster cast should not cause pain, tingling or numbness; for control, fingers and toes should be left uncasted. Cyanosis and swelling of the fingers indicate a violation of the venous outflow, their pallor and coldness - the cessation of arterial circulation, lack of movement - paresis or paralysis of the nerve. When these symptoms appear, the bandage is urgently cut along the entire length, and the edges are folded to the sides. If blood circulation is restored, the bandage is fixed with a circular plaster bandage, otherwise it must be removed and replaced with a new one. If local pain occurs, more often in the area of \u200b\u200bbone protrusions, a “window” should be made in this place to avoid the formation of bedsores. At long-term use Plaster casts may cause muscle atrophy and limited movement in the joints. In these cases, it is recommended after removing the bandage exercise therapy and massage.
Types of plaster casts
The main types of plaster casts: 1) circular, circular, deaf (unlined and lining); 2) fenestrated; 3) bridge; 4) milestone; 5) open (longet, tire); 6) combined (with twist, articulated); 7) corsets; 8) cribs.
A circular bandage (Fig. 2) is a deaf plaster bandage applied directly to the body (unlined) or to the body, previously covered with cotton-gauze bandages or knitted stockings (lining). Lining plaster bandage is used after orthopedic operations and for patients with diseases of the joints (bone tuberculosis).
The fenestrated plaster cast (Fig. 3) is also a circular bandage with a "window" cut over the wound; it is advisable if it is necessary to examine the wound, dressings.
For the same purposes, a bridge bandage is also used (Fig. 4), when it is necessary to leave at least 2/3 of the circumference of the limb open in any area. It consists of two sleeves fastened together by one or more plastered "bridges".
A staged plaster cast is used to eliminate contractures and deformities. A circular bandage is applied with a slight possible elimination of the deformity, and after 7-10 days it is cut into 1/2 circles in the deformity area and the position of the limb is corrected again; a wooden or cork spacer is inserted into the resulting space and the correction achieved is fixed with a circular plaster bandage. The next stage plaster casts are made in 7-10 days.
An open splint cast (Fig. 5) is usually applied to the posterior surface of the limb. It can be made according to a previously taken measurement from plaster bandages or splints, or rolled out bandages directly on the patient's body. You can turn a circular bandage into a splint plaster bandage by cutting out 1/3 of its front part.
A plaster bandage with a twist is used to eliminate persistent contractures. It consists of two sleeves connected by rope loops. By rotating the twist wand, they stretch the cord and bring together the points of its attachment.
A hinged plaster cast is used to treat bone fractures, if necessary, to combine the fixation of the damaged area with partial preservation of the function of the nearby joint. It consists of two sleeves interconnected by metal tires with hinges. The axis of the hinge must coincide with the axis of the joint.
Corset is a circular plaster bandage applied to the trunk and pelvic girdle in diseases of the spine. A special type of removable plaster cast used to immobilize the spine is a plaster bed.
The method of applying plaster bandages
Plaster bandages on the pelvic girdle and thigh. Unlined longet-circular Whitman-Turner hip bandage is used for a fracture of the femoral neck. Produce traction along the length, the leg is retracted outward and rotated inward. Wide splints are placed around the body at the level of the nipples and at the level of the navel, the other two are placed on the pelvis and thigh, and the bandage is fixed on the body and in the area of the hip joint with a plaster bandage, followed by plastering of the entire limb. A few days later, a stirrup is put in plaster for walking (Fig. 6). Due to the successful results surgical treatment this type of injury, the Whitman-Turner bandage is used extremely rarely.
A circular hip plaster cast is applied after orthopedic operations on the hip joint and in case of a fracture of the femoral diaphysis. It can be with a corset (semi-corset), belt, with or without a foot; the level of overlap depends on the nature of the disease and injury. A padded hip bandage with an additional “trouser leg” on the other leg and a wooden spacer (Fig. 7) is indicated after hip surgery, for example, after open reduction of a congenital hip dislocation. Plaster bandage of Lorentz (Fig. 8) is applied after bloodless reduction of congenital dislocation of the hips. Hip dressings are applied on a Holi-type orthopedic table (Fig. 9).
Plaster casts on the lower limb. In diseases of the knee joint (tuberculosis, infectious arthritis, osteomyelitis, arthropathy) and some cases of damage to the knee joint and bones of the lower leg, as well as after orthopedic operations on the lower leg (bone grafting, osteotomy, muscle tendon transplantation), various types of plaster bandages are applied depending on the nature , localization and degree of disease and damage. They can be up to the ischial fold, up to the upper third of the thigh, with and without a foot, circular and splint.
For various diseases and fractures of the bones of the foot and ankle joint, various types of plaster bandages are used, applied up to the knee joint. 1. Plaster boot - a circular plaster cast with an additional splint in 5-6 layers on the sole (Fig. 10). In the treatment of congenital clubfoot, when a boot is applied, the bandage should go from the fifth finger through the rear of the foot to the first finger and then to the sole. By tightening the bandage, the deformation is reduced. With valgus deformity of the foot, a boot is also applied, but the bandage is carried out in the opposite direction. 2. Splint bandage of various depths. When applying her patient, it is more convenient to lay on the stomach, bend the knee at a right angle; the doctor holds the foot in the desired position. 3. Longet bandage: measure the lower leg (from the internal condyle of the tibia along inside through the calcaneal region of the sole and further along the outer side of the lower leg to the head of the fibula) and roll out on the table a splint of appropriate sizes in 4-6 layers; another longuet, equal to the length feet attached to it. The plaster cast is applied from the outside through the foot, then along the inner surface. To avoid swelling, the splint is fixed with a soft bandage, and after 8-10 days with a t-gypsum bandage, while you can put a heel or a stirrup for walking.
Plaster cast on the upper limb. The imposition of plaster casts on the upper limb due to anatomical and topographic features is associated with a greater possibility of compression of blood vessels and nerves compared to the lower limb. Therefore, the fixation of the upper limb in most cases is carried out with a plaster splint. Its size is different. So, for example, after repositioning the dislocation of the shoulder, a posterior dorsal plaster splint is applied (from a healthy shoulder blade to the metacarpophalangeal joint of the diseased arm).
Plaster bandage for dislocation of the acromial end of the clavicle - a shoulder strap, consisting of an annular plaster belt, by means of which the forearm with the elbow joint bent at a right angle, is fixed along the anterior and anterior-lateral surface of the chest, and a half ring thrown over the damaged shoulder girdle in the form of a shoulder strap attached to a plaster belt in a state of tension (Fig. 11).
After surgery for shoulder joint and in some cases, after a fracture of the diaphysis of the humerus, a thoracobrachial plaster bandage is applied, consisting of a corset, a plaster bandage on the arm and a wooden spacer between them (Fig. 12).
Immobilization elbow joint after open reduction of intra- and periarticular fractures, after operations on tendons, vessels and nerves, a posterior plaster splint is performed (from the metacarpophalangeal joint to the upper third of the shoulder). In case of fracture of both bones of the forearm, two splints can be used: the first is applied to the extensor surface from the metacarpophalangeal joint to the upper third of the shoulder, the second - along the flexor surface from the middle of the palm to the elbow joint. After reposition of the fracture of the bones of the forearm in a typical place, a deep dorsal gypsum splint is applied (from the metacarpophalangeal joint to the upper third of the forearm) and narrow - along the palmar surface. Children are recommended to use only splint plaster bandages, since circular ones often lead to ischemic contractures. Adults sometimes have to apply circular plaster casts. In this case, as a rule, the arm is bent at the elbow joint at a right angle and the forearm is set in a position intermediate between pronation and supination; according to indications, the angle in the elbow joint can be acute or obtuse. The bandages are rolled out circularly, starting from the hand, and lead in the proximal direction; on the hand, the bandage should pass through the first interdigital space, with the first finger remaining free. The hand is set in the position of slight extension - 160° and ulnar deviation - 170° (Fig. 13). A circular plaster bandage from the metacarpophalangeal joint to the upper third of the forearm is indicated for fractures of the bones of the hand.
Plaster bandages for the treatment of diseases of the spine. To unload and fix the spine in case of its fractures, inflammatory and degenerative lesions, congenital defects and curvature, various plaster corsets are applied, which differ from each other depending on the area of the lesion, the stage and nature of the disease. So, with damage to the lower cervical and thoracic vertebrae up to the level of Th 10, a corset with a head holder is shown; in case of damage to Th 10-12 - a corset with shoulders, fix if necessary lumbar- corset without shoulders (Fig. 14). The corset is applied with the patient standing in a wooden frame or on the Engelmann apparatus (Fig. 15). Traction behind the head is carried out with a Glisson loop or gauze strips until the patient can touch the floor with his heels, the pelvis is fixed with a belt. The corset can also be applied when the patient is lying down (more often after surgical interventions) on the orthopedic table. In case of compression fractures of the lower thoracic and lumbar vertebrae with simultaneous reduction, the corset is applied between two tables that have different heights; in staged reclination according to Kaplan, a plaster corset is applied in the position of suspension by the lower back.
To apply a corset, wide plaster bandages are used, which are carried out mainly in circular or spiral passages. Tight coverage of bone points of support (scallops of the iliac bones, pubic area, costal arches, nape) helps to unload the weight of the corset. To do this, modeling begins after the first round of bandaging. Headrest - a circular plaster bandage covering the chin, neck, back of the head, shoulder girdle and upper part chest, indicated for lesions of the upper three cervical vertebrae. After surgery for congenital muscular torticollis, a plaster cast is applied with a certain setting: tilting the head to the healthy side, turning the face and chin to the diseased side (Fig. 16).
For scoliosis, various corsets were used. Sayre's corset, applied in an extended position, eliminates the deformity only temporarily. The removable Goffa detorsion corset aims to correct both the lateral displacement of the body and the rotation of the body relative to the pelvis with an elongated spine. In connection with the application surgical intervention Sayre and Goffa corsets are rarely used.
Abbott (E. G, Abbott), who recommended applying a very tight corset that compresses chest. After the plaster had hardened, a “window” was cut out on the back of the concave side of the curvature; with each breath, the ribs of the compressed convex side pushed the spine to the concave side, i.e., towards the cut out “window”, which provided a slow correction. The Abbott corset is sometimes used as one of the stages in the correction of spinal deformity.
Risser's corset (Fig. 17) consists of two halves connected by a hinge; the upper half is a short corset with a collar, the lower half is a wide belt with a trouser leg on the thigh from the side of the bulge of the curvature; between the walls of the corset along the concave side of the curvature, a screw device such as a jack is strengthened, with the help of which the patient is gradually tilted towards the convexity of the curvature, thereby correcting the main curvature. The Risser brace is used for preoperative deformity correction.
A plaster bed is used for diseases and injuries of the spine; it is designed for long periods. An example is the bed of Lorenz (Fig. 18): the patient is placed on his stomach, his legs are stretched out and slightly parted, his back is covered with a piece of gauze; bandages are rolled out on the patient and well modeled; splints or gauze layers soaked in gypsum slurry can be used. After manufacturing, the bed is removed, cut, dried for several days, after which the patient can use it.
Plaster technique in dentistry
Gypsum in dentistry is used to take casts (impressions), obtain models of dentition and jaws (Fig. 19-20), as well as face masks. It is used to make rigid headbands (gypsum helmets) that fix equipment for extraoral traction during orthodontic treatment, in case of jaw trauma and splinting devices. AT therapeutic dentistry plaster can be used as temporary fillings. In addition, gypsum is part of some masses for casting and soldering dentures, as well as a molding material for the polymerization of plastics in the manufacture of removable and non-removable dentures.
Removal of casts from the dentition and jaws begins with the selection of a standard spoon in the presence of teeth or the manufacture of an individual spoon for a toothless jaw. 100 ml of water is poured into a rubber cup and 3-4 g of sodium chloride are added to accelerate the hardening of gypsum, then gypsum is poured into the water in small portions so that the gypsum hill is above the water level; excess water is drained and the gypsum is stirred to the consistency of thick sour cream. The resulting mass is placed in a spoon, injected into the mouth and pressed on the spoon so that the plaster mass covers the entire prosthetic field. The edges of the cast are processed in such a way that their thickness does not exceed 3-4 mm; excess plaster is removed. After the gypsum has hardened (which is determined by the fragility of the gypsum residues in the rubber cup), the cast in the mouth is cut into separate fragments. Incisions are made from the vestibular surface: vertical along the existing teeth and horizontal - on the chewing surface in the area of the dentition defect. Plaster fragments are removed from the oral cavity, cleaned of crumbs, placed in a spoon and glued in a spoon with hot wax. To cast the model, the spoon with the impression is placed for 10 minutes. into water so that the impression is better separated from the model, after which liquid gypsum is poured into it, and after hardening, the model is opened by separating the impression gypsum from the model.
Removing a plaster cast from edentulous jaws is extremely rare. Gypsum in these cases is replaced by more advanced impression materials - silicone and thermoplastic masses (see Impression materials).
When removing the mask, the patient is given a horizontal position. The face, especially its hairy areas, is lubricated with vaseline oil; rubber or paper tubes are inserted into the nasal passages for breathing, the borders of the cast on the face are covered with cotton rolls. The entire face is covered with an even layer of gypsum approx. 10 mm. After the plaster has hardened, the cast can be easily removed. The mask is cast after the cast has been placed for 10 minutes. in water. To cast the mask, liquid gypsum is required; in order to avoid the formation of air bubbles, it must be evenly distributed over the surface of the cast and shaken frequently by hand or with a vibrator. The hardened model with the impression is placed in boiling water for 5 minutes, after which the impression plaster is chipped off the model with a plaster knife.
For the manufacture of a rigid plaster head bandage, a scarf of several layers of gauze or nylon is applied to the patient's head, and a plaster bandage is applied around the head, metal rods are placed between the layers to fix the equipment. The plaster bandage should capture the frontal and occipital tubercles. A nylon or gauze handkerchief makes it easy to remove and put on a plaster cast, which improves the gig. conditions for tissues under a rigid plaster cast.
Plaster technique in military field surgery
Gypsum equipment in military field surgery (VPH) is used to lay down. and transport and to lay down. immobilization. The priority of introducing a plaster cast into the arsenal of means of the VPH belongs to N. I. Pirogov. The effectiveness and advantage of plaster casts in comparison with other means of immobilization in the war were proved by him during the Crimean campaign (1854-1856) and in the theater of operations in Bulgaria (1877-1878). As E. I. Smirnov pointed out, the widespread use of plaster bandages for the treatment of the wounded in military field conditions ensured the progress of the domestic military-industrial complex and played a great role in the future, especially during the Great Patriotic War. In combat conditions, plaster bandages provide reliable transport immobilization of the injured limb, facilitate and improve the care of the wounded, create opportunities for further evacuation of most of the victims in the coming days after surgical treatment; the hygroscopicity of the dressing contributes to a good outflow of the wound discharge and creates favorable conditions for wound cleansing and repair processes. However, when using plaster casts, secondary displacement of fragments and the formation of contractures and muscle atrophy are possible.
In military field conditions, longet, circular and longet-circular plaster bandages are used. Indications: to lay down. immobilization for open gunshot and closed fractures of the bones of the limb, damage to the main vessels and nerves, as well as for extensive damage to soft tissues, superficial burns, frostbite of the limbs. The imposition of a blind plaster bandage is contraindicated in case of developing anaerobic infection (or suspicion of it), insufficiently carefully performed surgical treatment of the wound, in the early stages after operations on the main vessels (due to the possibility of developing gangrene of the limb), in the presence of unopened purulent streaks and phlegmon, extensive frostbite or extensive deep burns of the limb.
The use of plaster casts in the conditions of modern warfare is possible in institutions that provide qualified and specialized assistance.
In SMEs, gypsum technique can be used Ch. arr. in order to strengthen the transport splint for immobilization of the lower extremities (the imposition of three plaster rings) and the imposition of splint bandages. In exceptional cases, with a favorable medical and tactical situation, blind plaster bandages can be used.
In the working conditions of honey. services of GO plaster bandages can be applied in hospital bases (see).
Equipment: a field orthopedic table, an improved ZUG apparatus (Behler type), plaster in hermetically packed boxes or bags, ready-made non-shedding plaster bandages in cellophane packaging, tools for cutting and removing plaster bandages.
When working in military field conditions, it is necessary to ensure the imposition a large number plaster casts in a short time. For this purpose, in specialized surgical hospitals and profiled surgical hospitals, a plaster room and a room for drying superimposed plaster bandages (room, tent) located near the operating room and dressing room are deployed. The marking of the circular plaster cast facilitates the organization of observation of the wounded and triage during the evacuation stages; it is usually done in a visible spot on a wet dressing. The date of injury, surgical treatment, plaster cast is indicated, and a schematic drawing of bone fragments and wound contours is also applied. During the first days after the application of a plaster cast, monitoring of the condition of the wounded and the limb is required. Changes in normal color, temperature, sensitivity and active mobility of the parts of the limb (fingers) open for inspection indicate certain shortcomings in the technique of applying a plaster cast, which must be immediately eliminated.
Bibliography: Bazilevskaya 3. V. Plaster technique, Saratov, 1948, bibliography; Bom G. S. and Chernavsky V. A. Plaster bandage in orthopedics and traumatology, M., 1966, bibliogr.; Vishnevsky A. A. and Shraiber M. I. Military field surgery, M., 1975; To and p l and A. V. N. The closed damages of bones and joints, M., 1967, bibliogr.; KutushevF. X. id r. The doctrine of bandages, L., 1974; P e with l I am to I. P. and Drozdov A. S. Fixing dressings in traumatology and orthopedics, Minsk, 1972, bibliogr.; Pirogov N. I. Nalep-naya alabaster bandage in the treatment of simple and complex fractures and for the transport of the wounded on the battlefield, St. Petersburg, 1854; H e h 1 R. Der Gipsverband, Ther. Umsch., Bd 29, S. 428, 1972.
H. A. Gradyushko; A. B. Rusakov (military), V. D. Shorin (stomist).
97. Plaster and plaster bandages. Plaster bandages, splints. The main types and rules for applying plaster bandages.
Plaster bandages are widely used in traumatology and orthopedics and are used to hold fragments of bones and joints in position.
Medical gypsum - semi-aqueous calcium sulfate salt, is available in the form of a powder. When combined with water, after 5–7 minutes, the process of gypsum hardening begins, which ends after 10–15 minutes. The gypsum acquires full strength after the entire dressing has dried.
Using various additives, you can speed up or, conversely, slow down the process of gypsum hardening. If the gypsum does not harden well, it must be soaked in warm water (35–40 °C). Aluminum alum can be added to the water at the rate of 5–10 g per 1 liter or table salt (1 tablespoon per 1 liter). A 3% starch solution, glycerin delay the setting of gypsum.
Since gypsum is very hygroscopic, it is stored in a dry, warm place.
Gypsum bandages are made from ordinary gauze. To do this, the bandage is gradually unwound and a thin layer of gypsum powder is applied to it, after which the bandage is again loosely rolled into a roll.
Ready-made non-shrinking plaster bandages are very convenient for work. The plaster bandage is designed to perform the following manipulations: anesthesia of fractures, manual reposition of bone fragments and reposition with the help of pulling devices, application of adhesive traction, plaster and adhesive bandages. In some cases, it is permissible to apply skeletal traction.
Plaster bandages are dipped in cold or slightly warmed water, while air bubbles are clearly visible that are released when the bandages are wet. At this point, you should not press on the bandages, as part of the bandage may not be saturated with water. After 2-3 minutes, the bandages are ready for use. They are taken out, slightly squeezed and rolled out on a plaster table or directly bandaged the damaged part of the patient's body. In order for the bandage to be strong enough, you need at least 5 layers of bandage. When applying large plaster casts, do not soak all the bandages at once, otherwise the sister will not have time to use part of the bandages within 10 minutes, they will harden and will be unsuitable for further use.
Dressing rules:
- before rolling out the plaster, measure the length of the applied bandage along a healthy limb;
- in most cases, the bandage is applied in the position of the patient lying down. The part of the body on which the bandage is applied is raised above the level of the table with the help of various devices;
- a plaster cast should prevent the formation of stiffness in the joints in a functionally unfavorable (perverse) position. To do this, the foot is placed at a right angle to the axis of the lower leg, the lower leg is in the position of slight flexion (165°) in the knee joint, and the thigh is in the position of extension in the hip joint. Even with the formation of contracture in the joints lower limb in this case, it will be a support, and the patient will be able to walk. On the upper limb, the fingers are set in the position of slight palmar flexion with opposition of the first finger, the hand is in the position of dorsal extension at an angle of 45 ° in the wrist joint, the flexor forearm is at an angle of 90-100 ° in the elbow joint, the shoulder is retracted from the body at an angle of 15– 20 ° using a cotton-gauze roller placed in armpit. For some diseases and injuries, at the direction of a traumatologist, for a period of not more than one and a half to two months, a bandage can be applied in the so-called vicious position. After 3-4 weeks, when the initial consolidation of fragments appears, the bandage is removed, the limb is set in the correct position and fixed with plaster;
- plaster bandages should lie evenly, without folds and kinks. Those who do not know the techniques of desmurgy should not apply plaster bandages;
- places subject to the greatest load are additionally strengthened (the area of \u200b\u200bthe joints, the sole of the foot, etc.);
- the peripheral part of the limb (toes, hands) is left open and accessible for observation in order to notice the symptoms of compression of the limb in time and cut the bandage;
- before the plaster hardens, the dressing should be well modeled. By stroking the bandage, the body part is shaped. The bandage should be an exact cast of this part of the body with all its protrusions and depressions;
- after applying the bandage, it is marked, i.e., the fracture scheme, the date of the fracture, the date the bandage was applied, the date the bandage was removed, the name of the doctor are applied to it.
Methods for applying plaster bandages. According to the method of application, plaster bandages are divided into lined and unlined. With lining bandages, a limb or other part of the body is first wrapped with a thin layer of cotton wool, then plaster bandages are applied over the cotton wool. Unlined dressings are applied directly to the skin. Previously, bone protrusions (the area of the ankles, femoral condyles, iliac spines, etc.) are isolated with a thin layer of cotton wool. The first dressings do not compress the limb and do not give bedsores from gypsum, but they do not fix bone fragments firmly enough, therefore, when they are applied, secondary displacement of fragments often occurs. Unlined bandages with inattentive observation can cause compression of the limb up to its necrosis and bedsores on the skin.
By structure, plaster bandages are divided into longet and circular. A circular plaster bandage covers the damaged part of the body from all sides, a splint - only from one side. A variety of circular dressings are fenestrated and bridge dressings. An end bandage is a circular bandage in which a window is cut out over the wound, fistula, drainage, etc. It is necessary to ensure that the edges of the plaster in the window area do not cut into the skin, otherwise the soft tissues will swell when walking, which will worsen the conditions for wound healing. The protrusion of soft tissues can be prevented if each time after dressing the window is closed with a plaster flap.
A bridge dressing is indicated in cases where the wound is located in the entire circumference of the limb. First, circular dressings are applied proximal and distally to the wound, then both dressings are connected to each other by U-shaped metal stirrups. When connected only with plaster bandages, the bridge is fragile and breaks due to the severity of the peripheral part of the bandage.
Bandages applied to various parts of the body have their own names, for example, a corset-coxite bandage, "boot", etc. A bandage that fixes only one joint is called a splint. All other dressings must ensure the immobility of at least 2 adjacent joints, and the hip - three.
A plaster splint on the forearm is most often applied for fractures of the radius in a typical place. The bandages are laid out evenly over the entire length of the forearm from the elbow joint to the base of the fingers. Gypsum splint on the ankle joint is indicated for fractures of the lateral malleolus without displacement of the fragment and ruptures of the ligaments of the ankle joint. Plaster bandages are rolled out with a gradual expansion at the top of the bandage. The length of the patient's foot is measured and, accordingly, 2 incisions are made on the splint in the transverse direction at the fold of the bandage. The longueta is modeled and strengthened with a soft bandage. Longuets are very easy to turn into circular bandages. To do this, it is enough to strengthen them on the limbs not with gauze, but with 4–5 layers of a plaster bandage.
A lining circular plaster bandage is applied after orthopedic operations and in cases where bone fragments are soldered by callus and cannot move. First, the limb is wrapped with a thin layer of cotton, for which they take gray cotton rolled into a roll. It is impossible to cover with separate pieces of cotton wool of different thicknesses, since the cotton wool falls off, and the bandage will cause a lot of inconvenience to the patient when worn. After that, a circular bandage in 5–6 layers is applied over the cotton wool with plaster bandages.
Removing the plaster cast. The bandage is removed using plaster scissors, saws, plaster tongs and a metal spatula. If the bandage is loose, then you can immediately use plaster scissors to remove it. In other cases, you must first put a spatula under the bandage in order to protect the skin from cuts with scissors. Bandages are cut on the side where there are more soft tissues. For example, a circular bandage to the middle third of the thigh - along the posterior surface, a corset - on the back, etc. To remove the splint, it is enough to cut the soft bandage.