. Operative gynecology. n the skin and the peritoneum, and, in places where it isnot clearly seen, overlying fatty and loose fibrous tissue should be dissected oif,laying it bare. The fii)rous ring thus bared is not the tissue which must be brought together to close the hernia, butis merely a mass of dense connectivetissue which covers in the recti musclesand the true al)dominal fascia overlyingthem. The next step is to dissect ofE thistissue and to expose the rectimuscles below and the fasciaabove them. This may be doneeithei- by catching up a bit of the tissuewith forceps and cutting it off
. Operative gynecology. n the skin and the peritoneum, and, in places where it isnot clearly seen, overlying fatty and loose fibrous tissue should be dissected oif,laying it bare. The fii)rous ring thus bared is not the tissue which must be brought together to close the hernia, butis merely a mass of dense connectivetissue which covers in the recti musclesand the true al)dominal fascia overlyingthem. The next step is to dissect ofE thistissue and to expose the rectimuscles below and the fasciaabove them. This may be doneeithei- by catching up a bit of the tissuewith forceps and cutting it off in strijjswith scissors, or by lifting up the mus-cle, which can be easily palpated, and splitting the overlying scar tissue withscissors, as shown in Fig. 540. The underlying muscle is often found pale andatrophic. In the upper and lower angles of the opening the dissection must becarried deeper than at the sides in order to reach layeis of fibrous tissue strong?enough to hold firmly together when united by ^?^^^^^ Fig. 542.—Mattress Sutukes uniting the RectiMuscles and their Overlying The sutures, as a rule, euibrace more tissue thanis shown in the liure. 474 THE RADICAL CUEE OF HERNIA. After such a preparation the wound presents an entirely difierent appearancefrom that when first exposed, for now the natural layers of the abdominal wall, Fig. 513.—Incakcerated Umbilical Hernia in a Fat Woman, removed at Autopsy. The patient had anemia and fatty degeneration of the viseera, affeotinc chiefly the heart, liver, and The hernia was bi-lobed, the size of a childs head, and the skin over it was tense and red. The saccontained omentum and a part of the transverse colon twenty centimeters long. Old fibrous bands passedfrom the ring; at the neck of tlie sac to the contents at their entrance. Age, fifty-three. Autopsy natural size. the peritoneum, the muscles, the fascia, and the skin are all clearly brought toview l)y the clean dissection. HER
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
