Gynaecology for students and practitioners . Fig. 503. Operation eor Vesico-Vaginal Fistula. The edges hayebee:i rawed, and the sutures introduced so as to include all the tissuesexcept the mucous membrane of the bladder. irrigation, or by forcipressure, before the ligatures are tied. The rawededges of the bladder-mucosa are thus brought into apposition but arenot included in the stitches {see Fig. 503). Chromicizecl catgut is thebest suture-material to employ. The fault of this operation is that the PLASTIC OPERATIONS 829 edges of the fistula are held together under considerable tension, acon
Gynaecology for students and practitioners . Fig. 503. Operation eor Vesico-Vaginal Fistula. The edges hayebee:i rawed, and the sutures introduced so as to include all the tissuesexcept the mucous membrane of the bladder. irrigation, or by forcipressure, before the ligatures are tied. The rawededges of the bladder-mucosa are thus brought into apposition but arenot included in the stitches {see Fig. 503). Chromicizecl catgut is thebest suture-material to employ. The fault of this operation is that the PLASTIC OPERATIONS 829 edges of the fistula are held together under considerable tension, acondition unfavourable for healing by primary union. (6) In the flap-splitting operation an incision is made all roundthe fistula, cutting through the vaginal wall alone ; from this incisiontwo short longitudinal incisions are carried, one upwards towards the. Fig. 504. Flap-splitting Operation for Vesico-Vaginal Fistula. Thevaginal flaps have been raised and are held aside by forceps. A catgutstitch is seen, which inverts the edges of the aperture in the bladder-wall. cervix and the other downwards towards the meatus urinarius {seeFig. 504). By means of these incisions two flaps of vaginal waUare then dissected carefully off the subjacent bladder, until the latteris exposed for half an inch aU round the fistula {see Fig. 505). Theedges of the opening in the bladder are not incised, but the openingis closed by a continuous catgut stitch passed just outside the edgethrough the muscular wall alone, on each side of the fistula, so asto bring muscular waU in apposition with muscular wall and invertthe mucosa, in the manner of Lemberts peritoneal suture. The 830 GYNECOLOGY separation of the bladder from the vagina frees the former, and allowsthe edges of the opening to be drawn together with ease. A secondseries of interrupted stitches may then
Size: 1350px × 1850px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
