American medical digest. . ot cutthrough into the bowel. The denudedarea should be equal upon each side ofthe median line. The perineum needle which goes bymy name is more curved than the onein ordinary use. It is to be buried inthe tissue all the way across the peri-neum. The point is introduced into | the sound skin upon one side of theperineum, and pushed through until itappears at a corresponding point uponthe opposite side ; my finger in therectum shows me that it has not pene-trated the bowel, nor has it appeared inthe vagina. The suture is now looselyfastened with a shot. For the peri-n
American medical digest. . ot cutthrough into the bowel. The denudedarea should be equal upon each side ofthe median line. The perineum needle which goes bymy name is more curved than the onein ordinary use. It is to be buried inthe tissue all the way across the peri-neum. The point is introduced into | the sound skin upon one side of theperineum, and pushed through until itappears at a corresponding point uponthe opposite side ; my finger in therectum shows me that it has not pene-trated the bowel, nor has it appeared inthe vagina. The suture is now looselyfastened with a shot. For the peri-neum, I am using silver wire sutures. Iprefer the wire here to catgut or horse-hair, because I can leave the sutures infor a week or more, if necessary ; theydo not yield, nor do they excite irri-tation ; when the parts are ready, theywill easily come away. These stitches,commencing at the lower part of thewound, are introduced successively atintervals of less than half an inch, untilthe upper margin of the wound Before drawing the ligatures andfastening them, I have the surface ofthe wound washed with several syringe-fuls of carbolized water, in order tocleanse and disinfect the parts, and re-move blood-clots, etc. This is an im-portant precaution in order to securesuccess in all these plastic vesico-vaginal fistula failure is oftendue to the fact that the raw surfacesare not brought completely into appo-sition with each other on account ofintervening clots. (The method of DISEASES OF WOMEN AND CHILDREN, AND OBSTETRICS. 85 introduction of the sutures is shown inthe cut.) The shot is now pushed down on thelowest suture and clamped, and in thisway the six wires are successivelyfastened. You will notice that the edgesof the mucous flap are brought into con-tact with mucous membrane, and theskin with skin ; all the stitches are out-side in the perineum and none appearin the vagina. This avoids a cicatrixin the vagina, which might tear in herapproaching con
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Keywords: ., bookcentury1800, bookdecade1880, booksubjectmedicine, bookyear188
