Tamponade

TAMPONADE, TAMPONS (from French tampon - plug). Tamponade consists of filling wounds and cavities with appropriately folded pieces of gauze. For tamponade, white sterilized gauze of the highest quality, sufficient hygroscopicity, or antiseptic gauze impregnated with iodoform, xeroform, isoform, noviform, novioiodine, vioform, etc., is used. Iodoform gauze is prepared as follows: observing all the rules of asepsis, folded double strips of gauze are laid out on a sheet and evenly sprinkled with iodoform. The latter is first rubbed with a gauze ball and then firmly pressed and rubbed in with a glass iron (Professor Bergman's clinic). This method deserves preference over impregnation of iodoform with glycerin and rosin followed by autoclave sterilization of the tampons. With this method of preparation, the tampons lose a significant part of their absorptive capacity, and iodoform decomposes under the influence of sterilization and acts weaker. Carbolic, salicylic, and mercuric chloride gauze are not used in modern surgery. Hygroscopic cotton is also not used. Depending on the purpose of tamponade, tampons are used in dry or wet form. The length of tampons varies from 1 cm to 0.5 m, width - from 0.5 cm to 10 cm or more. Gauze for tampons is usually folded in half, with its edges turned inward. Tamponade is used to stop bleeding, in the treatment of infected wounds, in operations on organs of the abdominal cavity for drainage and to isolate infected areas from healthy ones, to prevent possible leakage of digestive tract juices into the free abdominal cavity when they are diverted outward or when the suture is unreliable. In inflammatory processes of the female genital sphere, vaginal tampons are used, most often impregnated with ichthyol. For tamponade of the abdominal cavity, Mikulich proposed a special type of tampon. Subsequently, they found application and proved themselves in tamponade of large wounds in other parts of the body (see Drainage). Tampons effectively stop capillary, parenchymatous, and most venous bleeding. In some cases, success can be achieved with tampons even in arterial bleeding from the rectum, vagina, nasal cavity, from deep wounds, including those of the abdominal cavity, parenchymatous organs, venous sinuses, the dura mater, and bone cavities. However, when removing tampons here, the possibility of secondary bleeding is not always excluded. Tamponade should be done moderately, as too tight tamponade can cause stagnation phenomena. Tampons inserted to stop bleeding are usually removed after 48 hours, but in bleeding into the abdominal cavity, from venous sinuses, to avoid secondary bleeding, tampons are sometimes left for 14 days. The best hemostatic tampons are those impregnated with iodoform, due to their tight adhesion to bleeding tissues. Iodoform gauze is harmless in most cases and irreplaceable in cases where putrefactive decomposition can be expected during tamponade (nasal cavity, vagina, rectum). Under conditions of putrefactive decomposition, the use of iodoform is dangerous due to the release of free iodine. Good hemostatic properties are possessed by tampons moistened with hot saline solution. Lejars recommends using tamponade with pieces of catgut for bleeding from the brain sinuses. In general, tamponade, due to its harmful effect on tissue regeneration, should be used only in cases where more perfect methods of hemostasis are impossible, but in some cases it is an indispensable measure as a hemostatic method (nasal tamponade). The use of tampons in the treatment of infected wounds is currently limited. The widest application of tampons is in operations on organs of the abdominal cavity for drainage and isolation. Sometimes tamponade refers to the filling of cavities with spontaneously flowing blood, for example, they speak of tamponade of the heart with acute bleeding into the pericardial cavity.

F. Yanishevsky. Tamponade and tampons in various modifications are used in obstetrics and in gynecological diseases. The material for tamponade consists of gauze, folded into strips of various thickness and width, long bandages, etc., or rolled into cylinders of various sizes, tied with strong thread with long ends left. Balls of cotton of various sizes (from the size of a walnut to the size of a child's fist) are also used, tied crosswise with strong thread with long ends. Tampons are sterilized in an autoclave. Gauze is often impregnated with antiseptics (iodoform, vioform, etc.). In some cases, moist gauze soaked in a solution of lysol (0.5-1%), rivanol (1%) and well wrung out to eliminate the hygroscopic properties of dry gauze is preferred (e.g., in tamponade of the uterus in cases of its atony). Tamponade is used as a final act after surgery to stop bleeding, e.g., tamponade of the vagina after operations on it, on the cervix (amputation of the cervix, incision of the external os) during abortion when it is not possible to completely stop parenchymal bleeding in a poorly contracting uterus, tamponade of the uterus after removal of submucous fibroids, etc. In some cases, when surgical intervention is contraindicated or impossible for some reason, a tampon is used to stop uterine bleeding in fibroids, climacteric bleeding, and in bleeding from a cancerous ulcer on the cervix. Tamponade of the uterus and vagina is very effective in postpartum bleeding (see Postpartum period). To stop bleeding, the vagina is carefully and sufficiently tightly tamponaded through mirrors inserted into the vagina. Too tight tamponade, by compressing the rectum and bladder, can be a source of painful pain, forcing the removal of the tampon ahead of time. Before introducing the tampon, the vagina is thoroughly washed with a solution of potassium permanganate, tincture of iodine, etc. The tampon is introduced with a speculum, which is used to press the tampon when removing the mirrors. The end of the gauze tampon remains outside the genital slit; in the case of tamponade with cotton tampons, the threads with which the tampon is tied remain outside. Tampons remain in the vagina from 6 to 24 hours. The downside of tamponade is infection. An increase in temperature and rapid pulse are indications for immediate removal of the tampon before the scheduled time. Tamponade is also used in operations for removal of the uterus through the vagina when there is no certainty of complete cessation of parenchymal bleeding. After emptying the pus per vaginam from the Douglas space, from the appendages of the uterus, tamponade is performed with a strip of gauze to separate the abdominal cavity from the infected focus; the tampon is removed on the 8th-9th day when there is no fear of disrupting the surrounding adhesions to the gauze; in these cases, it is preferable to combine the introduction of gauze with a rubber T-shaped drain or to use only a rubber drain. Tampons are also used for introducing and holding various medicinal substances in the vagina. One or two small cotton balls soaked in a solution of glycerin with ichthyol, iodine, etc., are introduced through a mirror into the posterior fornix and in front of the cervix. They are pressed by a dry cotton ball. A tampon can also be made from aseptic gauze. After 6-8 hours, the tampons are removed by the patient herself by the thread left outside. Before introduction and after removal of the tampon, the vagina is washed with some weak antiseptic solution. The therapeutic effect of this method is not great and apparently consists of the action of glycerin, which, attracting liquid to itself, thereby promotes cleansing of the cervical canal and erosion. Tampons can be introduced (in addition to glycerin) with boric acid, tannin, tigenol, and other agents. Sometimes anesthetics are added to the antiseptic substances (e.g., pantopon). Such tamponade is completely useless when it is left to the patient herself to perform. To achieve a mechanotherapeutic effect, which consists in pressure on the adjacent tissues, a special type of tamponade is used, called colunization of the vagina. A gauze bandage (1½-3 m long and 3-5 cm wide) is introduced into the vagina, the end of which is soaked in a solution of ichthyol in glycerin. The tampon remains in the vagina from 6 to 48 hours. Indication for the use of colunization is chronic parametritis. Contraindications are pregnancy, acute inflammatory processes, the presence of virulent pus. For vaginal tamponade, it is recommended to attach a weight to the lower abdomen in the form of a bag filled with sand (2-3 kg). The therapeutic effect consists of the initially occurring anemia of tissues with subsequent hyperemia after removal of the tampon. This leads to the resolution of chronically inflammatory processes. To this is added the influence of ichthyol, which, having disinfectant and bactericidal properties, exerts resorptive and analgesic action. Colunization is currently being replaced by the use of mud tampons, treatment by weight. Tampons soaked in a solution of tannin in glycerine (10%) are used as a temporary measure to hold a prolapsed uterus and vagina; generally, tampons find their application in vulvovaginitis, erosions, leucorrhea, and inflammatory processes of the female genital sphere.