Operative gynecology : . re- taken. It is now time toplace the internal figure-of-eight stitch, which isbest understood by reference tothe diagram. This suture isof formalinized catgut or silk-worm gut. It starts on theright-hand side, passes throughmucosa and underlying tissueto the muscle, then, withouttouching the muscle of thatside, it is carried across to theopposite side, and pierces thatmuscle from behind forward;it then goes to the muscle onthe first side, piercing it frombefore backward; finally, pass-ing to the opposite side, it isbrought out through the mucosaand the underlying tiss
Operative gynecology : . re- taken. It is now time toplace the internal figure-of-eight stitch, which isbest understood by reference tothe diagram. This suture isof formalinized catgut or silk-worm gut. It starts on theright-hand side, passes throughmucosa and underlying tissueto the muscle, then, withouttouching the muscle of thatside, it is carried across to theopposite side, and pierces thatmuscle from behind forward;it then goes to the muscle onthe first side, piercing it frombefore backward; finally, pass-ing to the opposite side, it isbrought out through the mucosaand the underlying tissues inthe same way and at a pointcorresponding to that of en-trance (see Fig. 182). One of the sutures pierces the muscles between thetwo silkworm gut stitches. The other is placed above the uppermost silkwormgut. When these sutures are tied the two muscles are brought into closeapproximation; they are also bound firmly to the vaginal mucosa. By tyingthem the posterior half of the perineal body is formed. As shown in the. Fig. 182.—Both Figure-of-eight Sutures have beentied. The muscles are closely united to one another. The cutedge of the mucosa is united internally. The mucosa isdrawn down to the muscles behind and the only suture seenis the long ends of the last figure-of-eight suture (4) whichhave not yet been cut. 1 and 2 close the perineal wound. HOLDEN S METHOD OF CLOSING RELAXED VAGINAL OUTLET. 307 picture, a wall of muscle is built up, covered on its posterior aspect by vaginalmucosa. Now, by tying the silkworm gut sutures the muscular wall is cov-ered in front by skin and subcutaneous tissue. A stitch or two of plain catgut is sometimes needed to approximate . .__. a few raw edges left at the uppermargin of the new perineal body(see Fig. 183). The advantages of this opera-tion are: 1. The vaginal outlet is nar-rowed. Its direction is made to lieat an angle with the direction of theupper part of the vagina, and theentire outlet is lifted up. Thischange in direction a
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
