. A manual of operative surgery . ch side of the urethral groove. These incisions are parallelto one another and to thegroove, and are placed alittle externally to the outermargins of the groove. They terminate at thecorona glandis by one ex-tremity, and at the ab-domen by the other. Ateach of these extremitiesof the two cuts two veryshort transverse incisionsare made at right angles,and are directed outwards. The minute and almostlinear flaps thus markedout are dissected up as faras the lateral cuts will allow.(2) The proximal endsof the two longitudinalincisions are now carriedvertically upw
. A manual of operative surgery . ch side of the urethral groove. These incisions are parallelto one another and to thegroove, and are placed alittle externally to the outermargins of the groove. They terminate at thecorona glandis by one ex-tremity, and at the ab-domen by the other. Ateach of these extremitiesof the two cuts two veryshort transverse incisionsare made at right angles,and are directed outwards. The minute and almostlinear flaps thus markedout are dissected up as faras the lateral cuts will allow.(2) The proximal endsof the two longitudinalincisions are now carriedvertically upwards on to the abdomen, and are unitedsuperiorly by a transverse wound. The abdominal flap isthus marked out. Its breadth exceeds a little the width ofthe interval between the parallel penile incisions, and its lengthis a little in excess of the length of the urethral groove whichis to be covered in (Fig. 149). This narrow flap, when separated from the parts beneath,is turned down for the purpose of forming a roof to the FIG. 149.—NELATON S OPERATION FOR EPI-SPADIAS. i, Raw surface left by abdominal flap ; 2, Rawsurface left by scrotal flap ; 3, Pedicle ofscrotal flap ; 4, Scrotal flap ; 5, Abdominalflap in position ; a b. Free edge of penileflap, beneath which the margin of the ab-dominal flap has been introduced. chap, xxii] NELATONS OPERATION FOR EPISPADIAS 603 The skin surface lies towards the penis, while the raw surfaceis uppermost or external (Fig. 149). The edges are unitedby sutures to the raw edges left by the dissecting up of theminute penile flaps (a, b). The free, upper or transverse,border forms the upper margin of the new meatus. Theunion of this flap is so made that the edges which are broughttogether overlap a little, the minute penile flaps overlappingthe margins of the abdominal flap. An extensive union is thusobtained. It was found that if the operation were left at this stagethe abdominal flap would by its contraction shorten the penis,curve it
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