A textbook of obstetrics . broad ligaments ; the preparation of peritonealflaps; amputation of the womb; the ligation of the uterinearteries ; and the oversewing of the stump, which is dropped. The abdominal wall may be closed by close-set, interrupted ;-s4 OBSTE TRIL OPERA 770AS. stitches,—the easiest plan for a beginner,—or by a few through-and-through, interrupted silkworm-gut sutures, which simplyserve to splint the wound—the peritoneum, the fascia, and theskin being united by separate running stitches of catgut. The technic of the Sanger operation is the same up to the pointwhen the child
A textbook of obstetrics . broad ligaments ; the preparation of peritonealflaps; amputation of the womb; the ligation of the uterinearteries ; and the oversewing of the stump, which is dropped. The abdominal wall may be closed by close-set, interrupted ;-s4 OBSTE TRIL OPERA 770AS. stitches,—the easiest plan for a beginner,—or by a few through-and-through, interrupted silkworm-gut sutures, which simplyserve to splint the wound—the peritoneum, the fascia, and theskin being united by separate running stitches of catgut. The technic of the Sanger operation is the same up to the pointwhen the child and appendages have been extracted from thewomb except that the uterine wall must not be torn but shouldbe clean cut with scissors. Then, instead of amputating theuterus, the uterine wound is carefully brought together by threesets of sutures ; one interrupted, of fine silk, set about an inchapart, inserted under the peritoneum running across the lower partof the wound above the endometrium and emerging on the oppo-. Fig. 593.—A, The interrupted sutures; B, the lower tier of the running catgut stitch. site side under the peritoneum ; the second, a running cat-gutstitch in two tiers, embracing the muscle only and ending oppo-site the point where it began, so that there is but one knot ; thethird, a running Lembert stitch of fine silk in the peritoneum,beginning above and running down, the needle being inclinedupward at each insertion to allow for the pull downward of thesuture when it is tightened ( Figs. 593 ana< 594)- Fritschs proposition to make the incision across the fundusuteri from tube to tube, instead of in the anterior abdominal wall,is receiving a practical trial in Germany. There seems to be nodecided advantage ill it except that the uterine wound is as far aspossible lr<»in the cervical canal, and, therefore, from subsequent CESA RE A N SE C 77 ON. 785 contamination. Hut should leakage occur, the woman is de-prived of a safeguard to which she has oft
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Keywords: ., bookcentury1800, bookdecade1890, bookidtex, booksubjectobstetrics
