Treatise on gynaecology : medical and surgical . at the fourchette and a little tothe side of the median line, and is called incomplete when it does notinvolve the anal sphincter. There are two degrees of incomplete laceration, in one of wdiichthe fourchette alone is torn, while in the other the tear is deeper andinvolves the muscular planes, without rupturing the sphincter vulva appears to be elongated posteriorly, and is wide open, andat the forchette there is a soft cicatricial surface. If the lesion is oflong standing, there is almost always a slight degree of cystocele anduterine
Treatise on gynaecology : medical and surgical . at the fourchette and a little tothe side of the median line, and is called incomplete when it does notinvolve the anal sphincter. There are two degrees of incomplete laceration, in one of wdiichthe fourchette alone is torn, while in the other the tear is deeper andinvolves the muscular planes, without rupturing the sphincter vulva appears to be elongated posteriorly, and is wide open, andat the forchette there is a soft cicatricial surface. If the lesion is oflong standing, there is almost always a slight degree of cystocele anduterine prolapse. 356 CLINICAL AND OPERATIVE GYNJECOLOGY. In the complete form the vulvar and anal orifices are thrown to-gether so as to form a cloaca, about which there are prominent foldsof mucous membrane. The recto-vaginal septum is rounded in a fullcurve, or like a pointed arch with doubly curved sides, and at itsapex there is often a small triangular portion of red rectal mucosa,which hangs like a pendant. The posterior column of the vagina may. Fig. 101 —Complete Rupture op the Perineum Involving the Recto-vaginal Septum. be isolated by a double laceration which gives it the aspect of auvula, but more commonly the laceration has passed to the left sideof this projection. The cicatricial tissue deforms the parts in a vary-ing manner, one of the borders of the opening being thick and theother thin, or a number of bridles may stretch across it (Fig. 101).The division of the tissues may reach up to the posterior cul-de-sacof the vagina. At the lower edges of the laceration the parts are drawn upward LACERATION OF THE PERINEUM. 357 by the action of the levator ani, and on the sides there may be a smalldepression corresponding to the stump of the si)hincter. There are two degrees of complete rupture, according as thesphincter and the anal orifice alone are torn or the recto-vaginal sep-tum is also divided (G. Thomas). This distinction is of value to theoperator, for the repair of t
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