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Mr Flibble
07-01-2014, 03:22 PM
I'm not talking about losing all the skin!

One of my peeps...had a bit of an Event. Most of one side of his face is a mess -- he lost an eye and the rest is, well he's been nicely carved up. Given he's in a sort of Renaissance age world, I was thinking there's a good chance the resulting mess would get infected.

Now if a surgeon were to remove said infected skin in order to stop the spread.....

Is he going to survive?
Is the skin going to grow back eventually (massive scarring I should think!) or is he going to have half a face that looks more like a skull?
Or....???

MDSchafer
07-01-2014, 04:28 PM
Significant infection + Renaissance level medical knowledge = death. The Renaissance was was about 300 years before Joseph Lister and Louis Pasture. Removing infected tissue likely wouldn't help because your exposing the tissue underneath to the outside. Staphylococcus aureus and cellulitis are both fairly deadly if not treated.

That said, it's a fictional world, so you can kind of do your own thing. As far as skin growing back, it all depends on how much of the underlying tissue was taken. If the muscle was taken there's not much of a chance of a normal face growing back. One thing they could do is roll back the skin and take the infected muscle, assuming that's what's infected, in that case you'd have slack skin over the surgical site.

Mr Flibble
07-01-2014, 04:42 PM
Ooh excellent. So if they remove muscles....hehehe. I mean, um, my poor character.

I was thinking they might well have some remedies for preventing infection (after taking away what's too far gone) but obviously not as effective as say antibiotics etc. Honey was used in history iirc. Cauterisation of some sort perhaps? I know that was in use for gunshot wounds in the 1500s. Not sure I'd want it on my face though....

Bolero
07-01-2014, 08:49 PM
Remember seeing a documentary (might have been a Time Team) where they were excavating a mass grave from a medieval battle. One of the dead had a long since healed bad jaw injury. They worked out, through the remains and accessing medical books of the period, that he'd been given quite an extensive reconstructive surgery for the earlier jaw injury. I remember something about wax being involved with the re-build - forgotten the details but it might have been used as a caste, not sure.
It was a technique learnt from the Moors.

It was also commented that the dead man must have been a valued retainer for his employers to have gone to that level of expense.

Mr Flibble
07-01-2014, 08:58 PM
Ooh awesome!

And the Moors you say? *strokes chinbeard* Part of this world is kinda-sorta-based on post Moorish Spain....

Oh I can use that, thanks!

MDSchafer
07-01-2014, 10:11 PM
Cauterization works well for small wounds like gunshots or arrow, and when it's a narrow, yet long cut, it would work as well. I don't know the exact size, but after a while cauterization stops been useful and starts being just a large burn.

Mr Flibble
07-01-2014, 10:28 PM
Good point, good point. Thank you both. Given me a few things to ponder anyway!

Maxinquaye
07-02-2014, 10:35 AM
Yeah, it's good to look into the Moors. Or Islamic medicine of the time. It was far advanced compared to contemporary European medicine. While Europeans thought putting cow-patties on wounds would heal, the Persians and the Arabs were building near modern hospitals. They, for one thing, understood the need for hygiene and the risk for infection. The also took the first steps to separate physical diseases from psychological ones.

https://en.wikipedia.org/wiki/Medicine_in_the_medieval_Islamic_world - wikipedia... but the links are good.

Maryn
07-02-2014, 08:05 PM
I can no longer cite a source, but one of my grandfather's medical books had a pen-and-ink illustration of a medieval skin graft to the face. It involved tying the arm to the head, peeling a large flap of skin off the arm and leaving one edge attached, and sewing the flap to the remaining facial skin. The person's head and arm would be kept immobile (in a shared bed, probably) until the graft took, then then skin would be cut free of the arm.

Maryn, who remembers that pretty vividly

benbenberi
07-03-2014, 03:29 AM
Cauterization works well for small wounds like gunshots or arrow, and when it's a narrow, yet long cut, it would work as well. I don't know the exact size, but after a while cauterization stops been useful and starts being just a large burn.

One of the revolutionary innovations of the surgeon Ambrose Paré in the 16c was that he stopped cauterizing solders' wounds (with boiling elderberry oil, the standard of care) and treated them with gentler compounds (egg & turpentine, among other mixtures) & had a much better survival rate. And he introduced the use of ligatures rather than cautery in amputations, also a great improvement in results.

MDSchafer
07-03-2014, 04:56 AM
One of the revolutionary innovations of the surgeon Ambrose Paré in the 16c was that he stopped cauterizing solders' wounds (with boiling elderberry oil, the standard of care) and treated them with gentler compounds (egg & turpentine, among other mixtures) & had a much better survival rate. And he introduced the use of ligatures rather than cautery in amputations, also a great improvement in results.

Cool, unfortunately it's another example of how slowly data traveled before the 1900s. Surgeons in during America's Civil War didn't even sterilize their equipment between amputations even though Joseph Lister and Florence Nightengale had been calling for it's use for a while by then. It's kinda stunning to remember that antibiotics are only about century old.

C.bronco
07-03-2014, 06:28 AM
This reminds me of Hannibal. Ew gross! However, not everything is always documented and some anachronisms could fly while suspending disbelief.

JulianneQJohnson
07-03-2014, 07:57 AM
Maggots! Did folks back then use maggots to eat the dead skin or flesh? Doc today still use them for things like gangrene.

Mr Flibble
07-03-2014, 07:17 PM
One of the revolutionary innovations of the surgeon Ambrose Paré in the 16c was that he stopped cauterizing solders' wounds (with boiling elderberry oil, the standard of care) and treated them with gentler compounds (egg & turpentine, among other mixtures) & had a much better survival rate. And he introduced the use of ligatures rather than cautery in amputations, also a great improvement in results.

OoooOOh! That sounds more like what I was thinking of (but great to have a specific, thanks)

I may forgo the maggots -- the poor man is going through enough without that :)

Orianna2000
07-05-2014, 01:25 AM
It's my understanding that maggots don't hurt. They only eat dead flesh, so while it's pretty disgusting, it doesn't hurt, because they're feasting on skin and muscle that's already died.

PeteMC
07-07-2014, 12:05 AM
Fair warning - some of these are reasonably unpleasant reading even by my standards, but should be helpful:

http://en.wikipedia.org/wiki/Maggot_therapy
http://www.monarchlabs.com/mdt
http://www.sciencemuseum.org.uk/broughttolife/themes/surgery/reconstructive.aspx
http://www.bbc.co.uk/guides/zxw42hv
http://archfaci.jamanetwork.com/article.aspx?articleid=479888

jennontheisland
07-07-2014, 05:18 AM
Definitely maggots. Input from someone on the south side of the Mediterranean. And also things like this http://en.wikipedia.org/wiki/Nasal_reconstruction_using_a_paramedian_forehead_f lap that were introduced to Europe by India.