Plastic surgery; its principles and practice . mation of a vagina may be essential for a continuationof marital happiness. The ethics in such cases have been the subject of a good deal of dis-pute. The operation should be undertaken only after mature con-sideration of all the various phases of each case. There are two general methods of operative procedure which havegiven some measure of success, (ij The formation of a vagina by theuse of pedunculated skin flaps from the labia and skin of the procedure has been successfully carried out by Heppner, Roux, 336 ATRESIA OF THE VAGINA 337
Plastic surgery; its principles and practice . mation of a vagina may be essential for a continuationof marital happiness. The ethics in such cases have been the subject of a good deal of dis-pute. The operation should be undertaken only after mature con-sideration of all the various phases of each case. There are two general methods of operative procedure which havegiven some measure of success, (ij The formation of a vagina by theuse of pedunculated skin flaps from the labia and skin of the procedure has been successfully carried out by Heppner, Roux, 336 ATRESIA OF THE VAGINA 337 Picque, Vautrin, Ferguson, Beck, Graves, Juvara, and others. Themethod of Graves is probably the best of the skin flap operations, andthe steps are well shown in the diagrams (Fig. 300). Skin grafts have been used by Abbe, Forgues, Isaac, Tuffier, andothers, and mucous membrane grafts (iso-vaginal mucosa) by Hirst,Kiistner, and Mackenrodt, to line the cavity burrowed between thebladder and rectum. Flaps of peritoneum (Stokelj have been used,. Fig. 300.—Operation for congenital absence of the vagina (Graves).—i. Through atransverse incision below the urethra a cavity of the desired size is burrowed between thebladder and rectum (care being taken not to enter the abdominal cavity.) This pocketis then lined by means of four pedunculated flaps. The labium minus on each side isdissected oS from above downward in such a manner as to leave a pedicle sufficiently largeto assure the circulation. The two surfaces are then split apart so that two paddle-shapedflaps are formed. A flap is raised from the inner side of each thigh with bases at the twolower corners of the artificial opening. All four flaps are sutured together over a glass form,skin side outward. Before the flaps are sewed together four catgut sutures with the endsleft long should be olaced in the vault of the artificial cavity. 2. When the suturing ofthe edges is nearly complete the glass form is taken out, and the long
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgeryplastic, booky
