. A manual of operative surgery . e groin flaps oneach side should be carriedwell down, so as to havetheir roots in great measureconnected with the \ the flaps are finallysutured together, the vaginashould be almost closed upby them, with but a smallopening to allow the passageof the urine. (See Mr. MayoRobsons modification of theoperation, page 626.)(c) Treatment of the Epispadias.—This is effected by Nelatonsoperation modified to meet the altered condition of the partsabove the opening into the bladder. (See page 602.) In theplace of the abdominal flap there described an incision
. A manual of operative surgery . e groin flaps oneach side should be carriedwell down, so as to havetheir roots in great measureconnected with the \ the flaps are finallysutured together, the vaginashould be almost closed upby them, with but a smallopening to allow the passageof the urine. (See Mr. MayoRobsons modification of theoperation, page 626.)(c) Treatment of the Epispadias.—This is effected by Nelatonsoperation modified to meet the altered condition of the partsabove the opening into the bladder. (See page 602.) In theplace of the abdominal flap there described an incision is madeparallel to and half an inch above the arched cicatrised urethralborder of the covering of the bladder, and the integument thusmarked out is then turned down in the form of a fold, with theskin surface directed towards the upper surface of the penis. With this exception the operation follows the lines alreadyindicated. Comment.—This operation meets successfully the two greatdifficulties which attended early FIG. 168 WOOD S OPERATION FOR ECTOPIAVESICAE. Lateral flaps ; c, Upper flap ; p, Pros-tate ; p, Penis. chap, xxii] ECTOPIA VESICA 625 i. In these cases a sinus was left at the site of the umbilicuswhich it was found almost impossible to close. Such a result may be certainly expected if lateral flaps areemployed in the fresh state without reversion or without theaddition of the umbilical flap. ii. The constant pressure upon the posterior wall of thebladder had in the early cases a tendency to cause a protrusionas the cicatrices contracted. As a result of this the openingabove the penis became larger and larger. This difficulty ismet partly by groin flaps of considerable size, which closelyembrace the root of the penis, and partly by means of the scrotalflap, which prevents the tissues about the opening from beingdrawn up as cicatrisation and contraction proceed. The scrotalflap is an essential feature in dealing with the epispadias. During the progress
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