Gynecology . re then inserted in the sides ofthe cervical tube close to the limit of the dissection, and held by the cervix is drawn strongly outward by the remaining traction forceps and thetubular core is amputated by a wedge-shaped incision, so that the uterine por-tion will be convex. This is an important maneuver, because it leaves a con-venient stump for the insertion of stitches through the cervical mucous mem-brane—the stump being held forward by the two traction forceps. If thisprecaution is not taken, the cervical mucous membrane will retract sharply 524 GYNECOLOGY bac
Gynecology . re then inserted in the sides ofthe cervical tube close to the limit of the dissection, and held by the cervix is drawn strongly outward by the remaining traction forceps and thetubular core is amputated by a wedge-shaped incision, so that the uterine por-tion will be convex. This is an important maneuver, because it leaves a con-venient stump for the insertion of stitches through the cervical mucous mem-brane—the stump being held forward by the two traction forceps. If thisprecaution is not taken, the cervical mucous membrane will retract sharply 524 GYNECOLOGY back, and be so hidden from view that it is difficult to place sutures in it. Duringthe dissection the bleeding may be little or great, depending on the amount ofcongestion in the individual case. The bleeding points are now tied, preferablywith No. 0 catgut. The placing of the sutures should be carried out with great precision, for itis to the exact approximation of the wound edges that the operation owes its. Fig. 212.—Amputation of the cervix has been amputated so that the stump juts from the surrounding tissue in the form ofa wedge. Three sutures have been introduced into the anterior lip of the cervical stump and contin-ued to the vaginal mucous membrane, taking in a little of the intervening tissue. Three other corre-sponding sutures are next passed through the posterior cervical wall in the same way. By the tyingof these six sutures the mucous membrane of the cervical canal and that of the vagina are exactlyapproximated. (See Fig. 214.) success. Inaccurate coaptation almost invariably results in local sepsis, withsometimes a very marked constitutional reaction. The cervical stump is held in the middle line by the traction forceps. Threesutures are placed through the anterior lip of the cervical stump including themucous membrane, and carried to the anterior edge of the vaginal flap (Fig. 212). OPERATIONS ON THE CERVIX 525 Three sutures are then passed through
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