Gynaecology for students and practitioners . Fig. 496. Complete Perineal Laceration. Stef the same case as Fig. 495. sphincter on each side. The anterior limbs of the incision are carriedforwards as already described. Step II. This step consists in splitting the recto-vaginal sept amso as to free the anterior rectal wall not only upwards but laterally oneach side as well. This must be done carefully on account of thetenuity of this septum, and it is often necessary to pass the finger uitothe bowel as a guide. In this case the gloved index finger is covered 822 GYNECOLOGY with a finger-
Gynaecology for students and practitioners . Fig. 496. Complete Perineal Laceration. Stef the same case as Fig. 495. sphincter on each side. The anterior limbs of the incision are carriedforwards as already described. Step II. This step consists in splitting the recto-vaginal sept amso as to free the anterior rectal wall not only upwards but laterally oneach side as well. This must be done carefully on account of thetenuity of this septum, and it is often necessary to pass the finger uitothe bowel as a guide. In this case the gloved index finger is covered 822 GYNECOLOGY with a finger-stall which is thrown away as soon as used. Strictattention must be paid to the lateral dissection, which must be. SPHINCTERSTITCH Fig. 497. Perineorrhaphy for Complete Laceration. The rectal stitcheshave been tied, the knots being concealed in the rectum. The sphincter hasbeen introduced, but not tied. The perineal stitches also have been intro-duced, but not tied. The dotted V-shaped line in the base of the vaginal flapindicates where the flap is to be cut away. thoroughly carried out in cases such as Figure 496, in order to allowthe edges of the V-shaped gap in the anal canal to come together PLASTIC OPERATIONS 823 without tension. If the stitches are tied under tension they willinevitably give way, and the whole wound will become infected andbreak down. This is the commonest cause of failure with the opera-tion. As soon as this dissection is completed the rectal stitches shouldbe introduced, as shown in Figure 496/and the canal thus closed.
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
