. Manual of operative surgery. Fig. 668. It is commonly believed that all except the most superficial fistulas runfrom the skin to the gut external to the internal sphincter, , that theypenetrate between the external and the internal sphincters. It is generallybelieved that division of the external sphincter is necessary to effect a cure notonly because of the free drainage secured, but because of the rest given to thewound while the muscle is hors de combat. Goodlee found at autopsies that the majority of fistulas are superficial tothe external sphincter and Mummery corroborated these fin
. Manual of operative surgery. Fig. 668. It is commonly believed that all except the most superficial fistulas runfrom the skin to the gut external to the internal sphincter, , that theypenetrate between the external and the internal sphincters. It is generallybelieved that division of the external sphincter is necessary to effect a cure notonly because of the free drainage secured, but because of the rest given to thewound while the muscle is hors de combat. Goodlee found at autopsies that the majority of fistulas are superficial tothe external sphincter and Mummery corroborated these findings by carefulobservation during operations. He writes If, when operating for fistula, onedivides the track to the internal opening by cutting down on to the directorwith an ordinary scalpel, instead of, as is more usual, transfixing it, it is quiteeasy to observe whether or not one cuts the fibres of the external have been surprised to find in how few cases the muscle has been cut. With 524 HEMORRHOIDS AND FISTU
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