. Gynecology : . at-tress sutures passed from the edge of the lower flap. The edge of the upperflap is stitched down on the underlying fascia. Numerous other excellent operations have been devised. Graser performsan operation which combines the principles of the two operations describedabove. He makes a transverse incision, dissects out and approximates therectus muscles, and sews up the fascia transversely. Blake and Webster havedeveloped operations similar in principle to the first operation described. 782 GYNECOLOGY OPERATION FOR POSTOPERATIVE HERNIA The operation for postoperative hernia u
. Gynecology : . at-tress sutures passed from the edge of the lower flap. The edge of the upperflap is stitched down on the underlying fascia. Numerous other excellent operations have been devised. Graser performsan operation which combines the principles of the two operations describedabove. He makes a transverse incision, dissects out and approximates therectus muscles, and sews up the fascia transversely. Blake and Webster havedeveloped operations similar in principle to the first operation described. 782 GYNECOLOGY OPERATION FOR POSTOPERATIVE HERNIA The operation for postoperative hernia used by the author is in principlelike that for umbilical hernia, though for hernias that occur in scars of lowpelvic operations the wound need not be so long. The principle to be observedis to unite the rectus muscles at a considerable distance above the hernia,so that at the site of the hernia there is no lateral tension in approximatingthe edges of the various layers of the abdominal wall. The method of re- / \. : G-ta\ic 5 --» Fig. 443.—The Mayos Operation for Umbilical step of overlapping and securing the fascia. duplicating the fascia at the point where there is greatest tension instead ofdissecting out the layers is to be observed in these hernias, as in the umbilicaltype. TRANSPLANTATION OF FASCIA FOR POSTOPERATIVE HERNIA In some cases of abdominal hernia neither the operation of approximatingthe rectus muscles nor the overlapping of flaps of fascia is feasible on account ofcausing too great tension on the tissues of the abdominal wall. In order to meetthis contingency various devices have been employed, such as the insertion of OPERATIONS ON THE ABDOMINAL WALL 783 metal plates, wire gauze, etc. These methods, though occasionally successful,are unsatisfactory and in principle unsurgical. A more rational method that bids fair to become of great importance in thetreatment has recently been introduced, and consists in the transplantationto the abdominal w
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