Gynaecology for students and practitioners . Eiu. 488. PEErNEORRHAPHY. Step II: Baising the Vaginal Flaphy Blunt Dissection. ostium vaginae at a point roughly corresponding to the posteriorextremity of the nympha on each side {see Fig. 486). By approximatingthese clips in the middle line, the size of the new ostium vaginae will beindicated ; it should be large enough to admit two fingers, and thepoints picked up in the forceps should be so adj Listed as to give a spaceof about this extent. The extremity of the posterior vaginal wall inthe mid-line is then seized with toothed dissecting forceps
Gynaecology for students and practitioners . Eiu. 488. PEErNEORRHAPHY. Step II: Baising the Vaginal Flaphy Blunt Dissection. ostium vaginae at a point roughly corresponding to the posteriorextremity of the nympha on each side {see Fig. 486). By approximatingthese clips in the middle line, the size of the new ostium vaginae will beindicated ; it should be large enough to admit two fingers, and thepoints picked up in the forceps should be so adj Listed as to give a spaceof about this extent. The extremity of the posterior vaginal wall inthe mid-line is then seized with toothed dissecting forceps, and a pairof sharp pointed scissors used to split the tissues from this point up to PLASTIC OPERATIONS 81i the lateral forceps on each side, as shown m Figure 487. This outlinesthe vaginal flap. Step II. This consists in raising the vaginal flap. The free edgeof the flap is with two or three pairs of forceps, and theseparation begun by snipping with sharp-pointed angled scissors. A. Fig. 489. Perineorrhaphy. Step II: The Vaginal Flap has been raised ; in the Depths of the Wound Lies the Rectum. The dotted line shows where the vaginal flap will be subsequently cut off. Fig. 489a. AngledScissors for Peri-neorrhaphy. good deal of old cicatricial tissue is often encountered at this stage,which must be carefully worked through, keeping as near as possible tothe vaginal mucous membrane. The dissection must be carried outon each side, to the full extent defined by the lateral pair of the cicatricial-tissue zone has been passed, the dissection can becontinued upwards through the connective-tissue layer wdth the fingerand a swab, aided by a few snips with scissors {see Fig. 488). Many largeveins will be seen, but these are almost all connected with the rectum 816 GYNECOLOGY {inferior hcemorrhoidal plexus) and can be peeled off the vaginal wall toa great extent uninjured. The separation of rectum and vagina canbe carried upwards in this way to any required exte
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
