You are told of three compartments. The parti-
tions between the Nitroglycerin Iv compartments are none of them
strong, and pus may pass from any one Ntg Nitroglycerin compart-
October 30, 1920.]
COUGHLIN: SURGICAL TREATMENT OF HAXD INFECTIONS.
669
ment to any other, for the partitions Spray Nitroglycerin fail as the
bases of Order Nitroglycerin the phalanges are approached. The parti-
tions are of fascia and Nitroglycerin 2 are backward extensions of
the deep palmar fascia. The outer compartment
lodges the thumb muscles, the inner one the flexor
tendons and short muscles of the little finger, while
in the middle we have the flexor tendons and lum-
bricals of the middle fingers, together with vessels
and nerves. Tendons and muscles must be sur-
rounded with loose areolar tissue,, or they will work
but stiffly, and infective material spreads readily
through loose areolar tissue. The deep palmar
fascia is strongest over the middle compartment,
and over all compartments the deep palmar fascia
thins out, becomes cribriform, and finally fails en-
tirely as we proceed distally. It disappears first in
the interdigital spaces, leaving the digital vessels
and nerves uncovered by it as they enter the webs
of the fingers.
Here the superficial fat of palm and web becomes
continuous with fat and areolar tissue under the
deep palmar fascia. One can thus see how readily
a primary superficial abscess can become a deep Nitroglycerin Tablet
palmar abscess by direct extension, Nitroglycerin Spray because the
fascia forming the roofs of the palmar compart-
ments is so strong and unyielding, and abscess in any
of the compartments may spread well up into the
wrist or forearm along the tendons or into its
neighboring compartment long before it points on
the surface of the palm. The swelling in the palm
is for the .same reason never marked until the ab-
scess is well advanced.
Swelling on the back of the hand is always
marked, but this swelling alone should not induce
one to incise the dorsum. It is nearly always Sl Nitroglycerin
lymphedema, because as before mentioned the lym- Buy Cheap Nitroglycerin
phatics drain toward the dorsum, but pus does some-
times collect here in the perifascial lymph space, and
here as elsewhere localized deep tenderness is an
early and never failing sign. The tender spot should
be opened as soon as found. To "squeeze out" the
pus is Sublingual Nitroglycerin the most primitive surgery.
How to open a palmar abscess is a real problem
and whether to incise vertically or transversely is
a moot question. A transverse incision will remain
open better while the fingers are extended, and the
fingers should always be dressed in extension, but
a transverse incision in the lower Nitroglycerin Sl part of the palm
exposes the digital vessels and nerves to danger,
while a vertical one higher up imperils the palmar
arch. The patient should be anesthetized and an
Esmarch bandage applied. One cannot use an Es-
niarch bandage to advantage unless the patient is
anesthetized ; hence the need for a general anes-
thetic and, besides, a local anesthetic in an inflamed
area is not often successful. We use the ether
rausch or ethyl chloride for such operations.^ Use
whichever incision you prefer, but identify the
structures before you cut them. Cut down Nitroglycerin Sublingual to the
deep fascia and proceed with Nitroglycerin Mg caution. Divide the
deep fascia and then lay down the knife. If you
have opened over the spot Buy Nitroglycerin Online most Iv Nitroglycerin tender on deep
pressure, go straight on with blunt dissection until
the pus appears. Do not pack, but insert soft rub-
ber and fasten it in the wound. Any drainage
material that presses on a tendon with any force
for even a few hours, may cause local death of the
latter. Nitroglycerin Tablets Nitroglycerin Buy If a Nitroglycerin Cream tendon or part of one dies, it takes
four to six weeks to separate and come away.
Immobilize fingers, hand and wrist, keep fingers in
extension, and use the hot bath or moist dressing.
Every student remembers the synovial sheaths
of the flexor tendons. He knows that Buy Nitroglycerin there is
around each set of flexor tendons, as they lie on
the phalanges, a strong fibrous tunnel through
which they run and which holds them to the bones.
P)Ut inside this fibrous tunnel is a synovial bursa,
as it were, which surrounds each set of tendons.
These synovial investments extend farther up into
the palm than do the fibrous sheaths : those for the
index, medius, and annularis extending up to the
middle of the palm, while those for the thumb and
little finger reach right up to join the bursa under
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