The practice of surgery . Fig. 215.—Flap-splitting operation for repair of perineum—step 1 (redrawn after Aitken). PERINEAL LACERATIONS 347 and descent, but also for sagging forward of the anterior rectal wall(reckxcle), and sagging backward and downward of the bladder (cys-toccle). The operation which 1 shall now describe remedies in greatmeasure both rectocele and cystocele. By the following operation we aim primarily to seek out and stitchtogether the ruptured fibers of the levator ani; to this end, split theseptum between the vagina and rectum through a crescentic incisiondrawn around the
The practice of surgery . Fig. 215.—Flap-splitting operation for repair of perineum—step 1 (redrawn after Aitken). PERINEAL LACERATIONS 347 and descent, but also for sagging forward of the anterior rectal wall(reckxcle), and sagging backward and downward of the bladder (cys-toccle). The operation which 1 shall now describe remedies in greatmeasure both rectocele and cystocele. By the following operation we aim primarily to seek out and stitchtogether the ruptured fibers of the levator ani; to this end, split theseptum between the vagina and rectum through a crescentic incisiondrawn around the lower border of the vagina or just within the lateral portions of this cut enter readily through the skin and super-ficial fascia, and open the ischiorectal fossa. So far there is no diffi-. Fig. 216.—Repair of perineum—step 2 (redrawn after Aitken). culty, but the separation in the median line, between the vagina andrectum, often demands a painstaking and laborious dissection througha great amount of tough scar tissue.^ By keeping close to the vaginalflap, however, one may avoid opening the rectum^an awkward com-plication. When the scar tissue has been dissected through, the vaginaand rectum peel apart readily, and then quickly with the fingers onedeepens the wound if needful up to the uterine cervix. There is not the 1 Tliis operation is in many respects that practised by Lawson Tait twenty-fiveyears ago, and still described as Taits operation in many of the text-books. I recog-nize it as Taits operation, but on carefully reviewing liis description cannot findthat he carried his dissection as deep as I feel generally to be advisable. 348 FEMALE OUGAXS OF GENERATION slightest danger of entering the peritoneal cavity. Often there is trou-blesome bleeding from large he
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
