Emergency War Surgery NATO Handbook: Part III: General Considerations of Wound Management: Chapter XXI: Amputations

Dressings

United States Department of Defense

A layer of sterile fine-mesh gauze soaked with betadine is placed over the wound, and the recess of the stump is dressed loosely with fluffed gauze or other suitable material. A stockinette for skin traction is then applied to the skin above the open stump. A liquid adhesive (benzoin tincture) to prevent slippage of the stockinette is used. The stump is wrapped with gentle compression, decreasing proximally, and 56 pounds of traction are applied with weights and pulleys or with a self-contained traction device (Figure 28). Constrictive wrapping at or above joints must be avoided. Traction should be reapplied after dressing changes and maintained continuously.

Figure 28

The amputation with preserved flaps requires individualized dressing consideration. The flaps should be held in their intended position by the dressing, although the major area of the amputation should be left widely open. No element of the flap should be suspended loosely within the dressing. No tacking sutures should be used. If possible, traction should be applied on the remaining skin elements and not on the flap.  

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Operational Medicine 2001

Health Care in Military Settings

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