Operative surgery . Fig. 1489.—Closing large ure-thral fistula. Oval freshen-ing. as a guide to the latter, and for the escape ofurine thereafter, as long as advisable. Tlte Comments.—The ill effects of the con-tact of urine with the freshened borders of theopening emphasizes the wisdom of the establish-ment of perineal drainage during the healing,unless especially contra-indicated. However, insome cases, the catheter can be borne by theurethra long enough to allow^ the wound toheal, thus avoiding the perineal element of thecase. If the catheter be well borne, its use maybe supplemented by a r
Operative surgery . Fig. 1489.—Closing large ure-thral fistula. Oval freshen-ing. as a guide to the latter, and for the escape ofurine thereafter, as long as advisable. Tlte Comments.—The ill effects of the con-tact of urine with the freshened borders of theopening emphasizes the wisdom of the establish-ment of perineal drainage during the healing,unless especially contra-indicated. However, insome cases, the catheter can be borne by theurethra long enough to allow^ the wound toheal, thus avoiding the perineal element of thecase. If the catheter be well borne, its use maybe supplemented by a rubber tube extendingfrom it to a vessel beneath the bed. Urethroplasty.—Urethroplasty is employedto close larger openings than those within thedomain of urethrorrhaphv. If flaps be dissected upon either sUle of the ^^t^iS Soopening, and drawn together and joined in the ders and lateral 1246 OPERATIVE SURGERY. median line, imperfect union is very apt to result on account of their thin-ness, median contact, and from sluggish granulation process. Nektons Method (Fig. 1491).—In Nektons method the edges of theopening are tirst pared, and then the integument is detached subcutaneouslyfor about an inch around it by entering a long, thin knife blade through atransverse cut just below the opening. The liberated integument is thenjoined in a longitudinal fold along the median line by means of quiltedsutures. Dieffenbach (Fig. 1492), instead of dissecting subcutaneously, raised twoparallel longitudinal flaps, and fastened the middle of their raw under sur-faces together by sutures passed through leather supports at each side. Twoor three rows of sutures can be used instead of this method of apposition. Delpecli dissected up a single flap, drew it across the fistula, and fastenedit to a raw surface prepared on the opposite side. Arlcmd made two trans-verse flaps, one in front
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