. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 46.—Immediate repair of small complete laceration. The deep retention:^titch is in place behind the sphincter ends. One catgut suture is laid in sphincterends for greater security. The upper portion of the vagina should be packed with sterile gauze to prevent obscuring of the field by blood escaping from the uterus, and the entire injured area should be inspected thoroughly with the labia separated, in order to ascertain the 9 130 INJURIES TO THE PERINEUM AND PELVIC DIAPHRAGM extent and character of the damage. T
. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 46.—Immediate repair of small complete laceration. The deep retention:^titch is in place behind the sphincter ends. One catgut suture is laid in sphincterends for greater security. The upper portion of the vagina should be packed with sterile gauze to prevent obscuring of the field by blood escaping from the uterus, and the entire injured area should be inspected thoroughly with the labia separated, in order to ascertain the 9 130 INJURIES TO THE PERINEUM AND PELVIC DIAPHRAGM extent and character of the damage. The first suture should beplaced upon the vaginal surface beginning at the apex of thewound in the vagina. Sometimes it is impossible to reach sohigh with the first stitch and in that event one may be placed as. Fig. 47.—Immediate repair of small complete perineal laceration. The deepretention stitch is tied and knot has disappeared in anus. Additional catgutstitch now to be tied. high as possible and left long, when traction upon its ends willexpose the upper portion of the tear. The sutures are inter-rupted rather than continuous, they should penetrate to the bottomof the wound, and be close enough together to approximate the IMMEDIATE REPAIR OF COMPLETE LACERATION 131 entire surface. The last vaginal stitch should be i to 2 cm. fromthe external surface, after which the remainder of the lacerationmay be closed by sutures passed from the skin side. Complete lacerations are first converted into incomplete andthen sutured as above. This conversion is readily accomplished,in tears which do not extend up the recto-vaginal septum butpass through the sphincter only, by the introduction of onesuture which enters the skin well behind the end of the externalsphincter muscle on one side, emerges on
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