Transactions of the American Association of Obstetricians and Gynecologists for the year ... . m). Superficial fascia (), and sections of the bulbocavernosus and ischiocavernosus muscles (f),together composing the outer stratum. The outer fascia (</), the inner fascia (?),and the deep transversus perinei muscle (/) between these, together constitutingthe fascial diaphragm. The levator ani muscle, the innermost, and chiefstratum (g). Fig. 3 shows this urogenital diaphragm, the trigone, or triangularligament. Its outer fascia layer has been removed on the right side LACERATIONS OF THE PERINEU
Transactions of the American Association of Obstetricians and Gynecologists for the year ... . m). Superficial fascia (), and sections of the bulbocavernosus and ischiocavernosus muscles (f),together composing the outer stratum. The outer fascia (</), the inner fascia (?),and the deep transversus perinei muscle (/) between these, together constitutingthe fascial diaphragm. The levator ani muscle, the innermost, and chiefstratum (g). Fig. 3 shows this urogenital diaphragm, the trigone, or triangularligament. Its outer fascia layer has been removed on the right side LACERATIONS OF THE PERINEUM. 133 to show the deep transversus perinei muscle, which constitutes themiddle layer of this three-ply structure whose inner borders con-stitute the most distinct and resistant structures about the vaginalintroitus. Fig. 4 represents the innermost stratum, the levatorani muscle whose outer fascia has been dissected off. Fig. 5 is adissection of the median line and one side of the perineum, whichshows parts of each stratum, in Fig. 6.—Line of first incision at the muco-skin junction. As to operative technic Fig. 6 shows about the usual first incisionat the muco-skin junction. From there the posterior vaginal wallis dissected up in a flap; bluntly, when possible; or, if necessarv,with blunt-pointed scissors. It is raised inward for a distance of5 to 6 cm., or more, from the plane of the hymen to a point 1 to 2 the previously located proximal border of the levator ani 134 A. GO L DSP OH X, structures, that have sometimes receded, and on the sides to thelevel of the white line of the pelvic fascia, as shown in Fig. S. Thelevator muscle is traced best by its tense fasciae between which itlies. It should not be dissected out from these, but should be picked
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Keywords: ., bo, bookcentury1900, booksubjectgynecology, booksubjectobstetrics
