. Gynecology : . ngle. One dissects then all thecellular tissue from the outer part of the triangle to the labium majus, completelydenuding the attachments of adductor longus and pectineus muscles and thefemoral vessels. If the tissues have been invaded and are voluminous it issometimes necessary to tie and divide the saphenous vein. The next step and one of importance is. to remove the glandular tissue be-neath the femoral ring. This is accomplished by cutting across Pouparts OPERATIONS ON THE VULVA 587 ligament (Fig. 217) and through the femoral ring just inside the femoral may even
. Gynecology : . ngle. One dissects then all thecellular tissue from the outer part of the triangle to the labium majus, completelydenuding the attachments of adductor longus and pectineus muscles and thefemoral vessels. If the tissues have been invaded and are voluminous it issometimes necessary to tie and divide the saphenous vein. The next step and one of importance is. to remove the glandular tissue be-neath the femoral ring. This is accomplished by cutting across Pouparts OPERATIONS ON THE VULVA 587 ligament (Fig. 217) and through the femoral ring just inside the femoral may even be necessary to incise the bony attachment of Gimbernats the cellular tissue of this region has been thoroughly cleaned out the roundligament is then tied and cut at its point of entrance into the peritoneal cavityand the ligament removed with the entire glandular fatty mass attached. Inorder to make a clean dissection it is necessary to tie the deep epigastric vesselsclose to their point of Fig. 217.—Dissection of the Inguinal Region for Cancer of the Vulva. Exposure of the lower chain of lymphatics by lifting up Pouparts ligament. The red line indicates the direction of the incision which is to divide Pouparts ligament. Exposure of the vessels. The final step is to restore the inguinal canal. The femoral ring is closed b}-suturing the internal oblique to the femoral fascia. Over this the severed endsof Pouparts ligament are sutured together. Basset recommends leaving in a small drain leading from the deep subperi-toneal space. Both inguinal regions should be dissected in the same radical manner. The second stage of the operation as described by Taussig is as follows: Two weeks later the inguinal wounds have healed, usually by first now proceed to an excision of the vulva, using neither scalpel nor only the cautery-knife. No attempt is made afterward to close the entire 588 GYNECOLOGY wound by a dissection of flaps. A half-doz
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