USE OF AZOCHLORAMID IN ACCIDENTAL WOUNDS
By M. S. Durkee. M.D.
Evansville, Indiana
Since June 1936 a revised routine has been utilized in my treat
ment of accidental traumatic wounds. Over three hundred patients representing all types of accidental wounds from small skin lacera
tions to severe mangling and contamination with dirt and other foreign bodies have been treated and lhe striking effects are lock of infection, minimum care and treatment and rapid healing. The basic principle in treatment has been the liberal and abundant use of Azochloramid 1/500 in and about lhe wound. The usual pro
cedure is lo cleanse the wound margins of dirt and grease, shave off surrounding hair, remove foreign bodies and devitalized tissue from the wound and liberally apply Azochloramid throughout lhe wound.
Bleeders are lied off and the wound sutured with as near anatomical approximation as possible. Drains of any type have been very rarely used.
In a few cases deliberate neglect was practiced when lhe patient happened to be of lhe shiftless, intoxicated, transient type. As an example one of this type of patients obtained a contused stellate scalp laceration about 7 cm. in widest diameter when thrown from a box car. This patient besides being just generally dirty from lack of cleanliness had landed in a pile of cinders and lhe wound was filled with these. In this case lhe scalp was not shaved, hands were not scrubbed (merely washed with soap and waler a few minutes) and rubber gloves were not worn. The wound was cleansed with a gauze sponge soaked in Azochloramid. Dirt and cinders were removed only by sponging. The wound was then sutured with interrupted dermal and a dressing of Azochloramid applied. Recovery was uneventful, sutures were removed on lhe sixth day and dressing permanently removed on the ninth day.
Several other wounds have been treated in this manner and to date no complications have been encountered.
As further evidence of the effectiveness of Azochloramid. lhe following cases are cited.
Two boys 17 and 18 years of age while riding a motorcycle ran head on into an auto. The driver was thrown over lhe handle*
<7
N-N'-piCHLOROAZODICARBONAMIDINE
an unusually stable chlorine germicide, odorless, non-lrrltallng and non-selactive in bactericidal Aiochloramid'i exceptional stability randan ilparticularly valuablelor lhe dretsing, pecking and irrigation olinfectedwound),eavilietand abteettea ol various kind* and degree*and a*
aprophylactic agent lo prevent inleclion el poit-oparative end traumatic wound*.
Asochloramid Solution »nTriacalin 1:300,an oily solution utadundiluted. Will prevent drossing*
adhering lowounds diminishinglhe likelihood ol
Asochloramid Solution in Triacelin in 1:125to prepare a solutionin Oli«*Oil 1:2000 Suitable lor useon almost allmucousmembranes.
Asochloramid Salina Mixture Torlhe easyprepara
lionol an isotonic irrigating solution 1:3300 Thia solution retainsits buffered lo pM
effective strength lor monthsandis readylor use as needed.
WALLACE & TIERNAN PRODUCTS, INC.
Ill i I I V11 I I'.XFW JERSEY. V. S. A.
LEVY & BLUM, INC.
35 Plaia Santa C r u i, Manila
The CADUCEUS «Q bars against a telephone pole and secured a ten inch laceration of lhe forehead and scalp and a large triangular laceration of the inner aspect of the right thigh with loss of an area of skin about 13 cm. in diameter. This laceration extended into lhe abductor muscle group. The passenger of the motorcycle was thrown side
ways against lhe license plate of the auto and secured a laceration of lhe scrotum so that when seen in the emergency surgery, his left testicle was lying free against lhe left thigh. All these wounds were treated with Azochloramid and sutured without drains and resulted in primary healing. The laceration of lhe thigh was enlarged with a scalpel so that skin could be shifted in a sliding graft and a Y shaped wound resulted. The center of the Y sloughed due to lock of blood supply but soon granulated in.
A white female age 44 trespassing in a railroad yard during a rainy afternoon, was struck by a backing switch engine and shoved about 25 feet. This resulted in a loss of skin from two inches below the right knee on lhe medial side of lhe leg lo below the internal malleolus. The fascia of the peroneal muscles was tom and the muscle herniated through. The wound was Filled with wet dirt and cinders. Under spinal anesthia the wound was thoroughly cleansed and all foreign macroscopic bodies meticulously removed with a thumb forceps. Debridement of devitalized tissue was done and the wound filled with Azochloramid. The fascia was sutured and renlion silk worm sutures placed across the wound to hold the skin edges as close together as possible. This left a gaping wound about 6 cm. across and extending from below knee to ankle. The wound was kept soaked with Azochloramid and a heal cradle ap
plied. The patient s temperature never rose above 99-6. There was no sign of pus at any lime although some of lhe tissue sloughed.
After three weeks a good bed of granulations had developed and Thiersch's in grafts were applied. These look well and patient was released after an additional 18 days.
A white male, age 14. fell from a bicycle against a license plate of an auto and secured a deep S shaped laceration of the dorsum of the right forearm. This laceration started just distal to the elbow, swept down the forearm to lhe terminal end of lhe ulna and then across the back of the hand. The resultant wound was a tangled mass of several extensor tendons, fascia and skin. The wound was cleansed, dirt and dead tissue removed. Tendons were sutured and tissue approximated as near as possible without tension.
LANTOL
ELECTRIC COLLOIDAL RHOJ I UM
LAB.CH.COUTURIEUX 18, AVENUE HOCHE PARIS
LEVY 2: SLUM !NC
_______ PLAZA STA.CRUZ MANlia —_
ifR1 4 ■ d
| 1- ’
I n
1 Wirr
K4 WT Os™ rr ruXtEJ
m ’B •. I ■ V
n 1 B
■ ■
1' J I k J
■ ■
■ m. I
i - fl
ER Sy > BtM
1
■il Sy
t—i—i i 'i
M i '~r ~
IB ;1 W -U4-rti 1XP-+4- ht y* nTViXf
Tho CADVCEUS ii Azochloramid was nol used in lhe primary treatment. On lhe 5 rd day lhe palient had a (hill and developed a temperature of 101. On the 4lh day lhe skin wound was opened by removing some of lhe sutures and a thin sero purulent pus escaped. The tissues were then infiltrated with Azochloramid using an Ascpto syringe. By the 6lh day temperature had lowered to (X).6 and the amount of drainage decreased. Daily treatment with Azochloramid wns done for a week and al lhe end of that lime the drain age had practically ceased. The skin wound had gaped uhotii 1 cm. and was filled with healthy granulations. Al lhe end ol lhe third week llie wound had healed entirely except for an area about llie size of a quarter.
There wns about 50% motion of lhe fingers and wrist and this later improved io about 80%. In this case. I believe tbul had Azocldorn- mid been used in the primary treatment, lhe complication of infection would have been avoided.
The few cases cited are picked al random and do nol inlend to advocate lhe use of Azochloramid lo supplant olher methods of prophylaxis that have been proven to be successful. Many papers have been written attesting lo lhe efficacy of Azochloramid in lhe treatment of infections and infected wounds but none lo my knowl
edge have suggested ils use as a preventive measure and since my own experience has been gratifying, I pass il on lor what il is worth.
Summary
1. Azochloramid 1/500 in Triacetin has been proven lo be of value in treatment of infected wounds.
a. This paper suggests its use in primary treatment of wounds as a prophylactic measure to prevent infection.
