. Gynecology : . Fig. 416.—Omental triangular piece of omentum has been attached to the posterior wall of the uterus by several catgut sutures. dominal wound and inspected as in Fig. 415. A portion having been selectedwhich contains a good blood-supply, a wedge-shaped piece is exsected of a size MYOMECTOMY OPERATIONS 755 sufficient to cover the area on the surface of the uterus requiring cut edges of the omentum are sewed together after ligature of the bleeding j^\\ow\cv:. ;V Fig. 417.—Vaginal the pedicle. vessels. The omental graft is
. Gynecology : . Fig. 416.—Omental triangular piece of omentum has been attached to the posterior wall of the uterus by several catgut sutures. dominal wound and inspected as in Fig. 415. A portion having been selectedwhich contains a good blood-supply, a wedge-shaped piece is exsected of a size MYOMECTOMY OPERATIONS 755 sufficient to cover the area on the surface of the uterus requiring cut edges of the omentum are sewed together after ligature of the bleeding j^\\ow\cv:. ;V Fig. 417.—Vaginal the pedicle. vessels. The omental graft is then applied to the uterus and stitched in place bya few interrupted sutures of fine catgut as in Fig. 416. 756 GYNECOLOGY VAGINAL MYOMECTOMY By vaginal myomectomy is meant the removal of pedunculated submucousmyomata through the vagina, and not, as it is used in some books, the enuclea-tion of intramural and subperitoneal tumors by vaginal section, a procedurewhich is not recommended by the present writer. Pedunculated submucous myomata first make themselves evident by bleed-ing or by a foul discharge, or by both. They are usually necrotic and they are associated with intramural and subserous fibroids, as they commonlyare, it is best to remove the submucous tumor first, and to perform the radicaloperation for extirpation of the uterus at a later date. Otherwise there ismuch danger of sepsis. In removing a polypoid myoma the patient is in the perineal position and,preferably, u
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