. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 45. -Repair of recent small incomplete midline perineal laceration,sutures are tied and approximate depths of wound. Skin are necessary. If the stitches are passed very soon after de-livery no anaesthetic is required. The immediate repair of complicated lacerations, those ex-tending into the vaginal sulci or passing through the recto-vaginal septum, should be viewed as a distinct surgical operationto be carried out under thorough aseptic precautions, in a good I I COMPLICATED LACERATIONS 129 light, and with plent
. A manual of gynæcology and pelvic surgery, for students and practitioners. Fig. 45. -Repair of recent small incomplete midline perineal laceration,sutures are tied and approximate depths of wound. Skin are necessary. If the stitches are passed very soon after de-livery no anaesthetic is required. The immediate repair of complicated lacerations, those ex-tending into the vaginal sulci or passing through the recto-vaginal septum, should be viewed as a distinct surgical operationto be carried out under thorough aseptic precautions, in a good I I COMPLICATED LACERATIONS 129 light, and with plenty of assistance. An anaesthetic is neededunless the patient has unusual fortitude. The hurried repairof bad perineal tears immediately after delivery, and while thepatient and attendant are both exhausted, needs only be men-tioned to be Fig. 46.—Immediate repair of small complete laceration. The deep retention:^titch is in place behind the sphincter ends. One catgut suture is laid in sphincterends for greater security. The upper portion of the vagina should be packed with sterile gauze to prevent obscuring of the field by blood escaping from the uterus, and the entire injured area should be inspected thoroughly with the labia separated, in order to ascertain the 9 130 INJURIES TO THE PERINEUM AND PELVIC DIAPHRAGM extent and character of the damage. The first suture should beplaced upon the vaginal surface beginning at the apex of thewound in the vagina. Sometimes it is impossible to reach sohigh with the first stitch and in that event one may be placed as
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