Gynecology . TUlOVAic^Xi Fig. 392.—Suspension of Kidney. Retraction of latissimus dorsi muscle, exposing the superior lumbar trigonum. The lumbar fascia has been pierced, allowing the retroperitoneal fat to extrude through the opening. oblique muscles, the fibers of which meet each other at a slight angle. At thelower edge of the retracted wound the muscles diverge, leaving a small triangular 686 GYNECOLOGY fascial space—the so-called Petits triangle; directly opposite this triangle, atthe upper edge of the wound, can be felt the tip of the twelfth rib (Fig. 391). A small retractor is then ins
Gynecology . TUlOVAic^Xi Fig. 392.—Suspension of Kidney. Retraction of latissimus dorsi muscle, exposing the superior lumbar trigonum. The lumbar fascia has been pierced, allowing the retroperitoneal fat to extrude through the opening. oblique muscles, the fibers of which meet each other at a slight angle. At thelower edge of the retracted wound the muscles diverge, leaving a small triangular 686 GYNECOLOGY fascial space—the so-called Petits triangle; directly opposite this triangle, atthe upper edge of the wound, can be felt the tip of the twelfth rib (Fig. 391). A small retractor is then inserted so as to draw back the edge of the latissimusdorsi. This exposes the lumbar fascia covering the area called the superiorlumbar trigonum. The lumbar fascia is readily separated from the overlyingmuscles, having only a filmy cellular connection with them. The next step isto perforate the lumbar fascia (Fig. 392). If the border of the latissimus dorsi. yuabXuvuV) Fig. 393.—Suspension of Kidney. Transverse incision through the fibers of the latissimus dorsi muscle parallel to the inferior border of the last rib. Used when more room is necessary (adapted from Kelly and Burnam). muscle extends down too far, as it sometimes does, its fibers may be cut trans-versely in the direction of the vertebral column. The opening of the lumbar fascia is now enlarged by inserting two fingersof each hand and exerting strong traction in an up-and-down direction (). By this maneuver, which causes no injury to blood-vessels or nerves,the wound is readily made large enough to insert the hand. The enlargementof the wound brings to view on its inner side the border of the quadratus lum- OPERATIONS ON THE KIDNEY 687 borum muscle, under the edge of which, running parallel with its fibers, canalways be found the first lumbar nerve. The nerve is seen either as a single ordouble trunk. It is of great importance to avoid injuring this nerve either by-tr
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