Gynecology . Xwk^.G-cartas Fig. 246.—Operation fob Complete Tear of the silkworm-gut sutures have been tied, cut, and shotted. During convalescence the wound requires unremitting attention with ex-pert nursing, under the utmost antiseptic precautions. The bowels are keptclosed for from nine to twelve days and then moved with oil catharsis. Theexternal stitches are removed on the ninth day. If a stitch shows signs of infec-tion before that, it is best to remove it. Catgut for the external stitches is inter-dicted. 552 GYNECOLOGY When the tear extends far up the rectovaginal septum,
Gynecology . Xwk^.G-cartas Fig. 246.—Operation fob Complete Tear of the silkworm-gut sutures have been tied, cut, and shotted. During convalescence the wound requires unremitting attention with ex-pert nursing, under the utmost antiseptic precautions. The bowels are keptclosed for from nine to twelve days and then moved with oil catharsis. Theexternal stitches are removed on the ninth day. If a stitch shows signs of infec-tion before that, it is best to remove it. Catgut for the external stitches is inter-dicted. 552 GYNECOLOGY When the tear extends far up the rectovaginal septum, the denudation ofthe vaginal portion is central and not in the lateral sulci. The denudationbegins above the upper angle of the wound, and is carried down on either sideto the Bartholin ducts. Only a small amount of vaginal tissue should be removedin the region of the introitus, for if this precaution is not observed there is muchdanger of closing the perineum too Fig. 247.—Operation for Complete Laceration of the Perineum. (Warrens apron method.)The sphincter muscles are exposed by turning down a flap which, when sewed up,.is supposed to prevent the wound from contamination by the bowel,rectovaginal septum has been torn. The operation is not applicable when the The surest results are gained by using silkworm-gut to close the vaginalpart of the wound, notwithstanding the annoyance of having to remove themlater, catgut not being dependable in these cases. Buried rows of catgut sutures,closing the wound in layers, seem at the time of operation to unite the woundwith great strength, but the catgut is treacherous, and in the long run theresults from its use are inferior to those where the hard, non-absorbable suturehas been employed. Rectovaginal fistula is usually associated with a tear through the sphincter OPERATIONS ON THE VAGINA 553 muscle, and is due, as a rule, to the healing over of the intervening tissue. Itis often seen in cases in whic
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