Operative gynecology : . two other essentially different plans havebeen successfully carried out by F. Vulliet and A. F. McGill. Vulliets procedure (Nouv. arch, dobst. et de gyn., 1887, p. 512)consists briefly in the union of the tissues denuded on the vaginal surface bytwo layers of sutures, one buried and one superficial. The patient had had a fistula for seven years, and had already been operatedupon three times, with the effect of filling in the deficiency, about 2 cm. in diameter, with a thin layer of scar tissueperforated in three places like a sieve. Thistissue, not available for plasti
Operative gynecology : . two other essentially different plans havebeen successfully carried out by F. Vulliet and A. F. McGill. Vulliets procedure (Nouv. arch, dobst. et de gyn., 1887, p. 512)consists briefly in the union of the tissues denuded on the vaginal surface bytwo layers of sutures, one buried and one superficial. The patient had had a fistula for seven years, and had already been operatedupon three times, with the effect of filling in the deficiency, about 2 cm. in diameter, with a thin layer of scar tissueperforated in three places like a sieve. Thistissue, not available for plastic purposes,was sacrificed, and a denudation 8 mm. indiameter made around its border in thesound tissue. The anterior and posteriorextremities of the fistula were then caughtwith forceps and pulled in opposite direc-tions until the edges came into contact. Thefirst suture was then introduced, threadeddirectly in a small needle. The suture,made of silk and permeated with iodol andglycerin, was passed continuously along the. Fig. 254.—Vesico-vaginal Fistulaclosed by using a buried suture opCatgut in the Bladder Wall andthen uniting the vagina over this. margin of the fistula, entering and re-enter- ing at points close together. By this means alone the closure was so effective that no more fluid escaped from the bladder in spite of the coughing and straining under anesthesia. Another layer of sutures was then applied below this one, completely closing the wound. Seven days. later the superficial sutures were taken out, and the union found perfect. An interesting method is that of A. F. McGill, of Leeds {Lancet, Novem-ber 8, 1890, p. 9G7), entitled An Operation for Vesico-vaginal Fistulathrough a Suprapubic Opening in the Bladder. The patient, seventeen yearsold, had an opening in the vesico-vaginal septum just in front of the os uterilarge enough to admit the tip of the index finger. The operation was performed January 11, 1890. The pelvis was elevatedand the bladder opened above
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
