. Pelvic inflammation in women. Fig. 15.—Sagittal Section of the Inverting Stitch. operative field is brought well down toward the vulva. The cervical canalat the utmost limit of the cone is now opened and a single tenaculum is introduced into the canal (Fig. 14)for the purpose of further bringingthe cervical stump down nearer thevulva. When this is done the re-mainder of the cone is excised. Thevaginal flap originally liberated at thebeginning of the operation is now in-verted into the hollowed out shell ofthe cervix by the double invertingstitch of Sturmdorf. This maneuverbrings the cuff of
. Pelvic inflammation in women. Fig. 15.—Sagittal Section of the Inverting Stitch. operative field is brought well down toward the vulva. The cervical canalat the utmost limit of the cone is now opened and a single tenaculum is introduced into the canal (Fig. 14)for the purpose of further bringingthe cervical stump down nearer thevulva. When this is done the re-mainder of the cone is excised. Thevaginal flap originally liberated at thebeginning of the operation is now in-verted into the hollowed out shell ofthe cervix by the double invertingstitch of Sturmdorf. This maneuverbrings the cuff of vaginal mucosa intocontact with the cervical mucosa andthus completely covers all the denudedareas, and furthermore, substituteshealthy vaginal mucosa as a lining tothe canal for the infected cervicalmucosa which has been stitch is of silkworm gut and,when tied, not only coaptates the vaginal mucosa to the cervical mucosa,but controls bleeding from the tissues through which it passes ( Fig. 16.—When This Is DrawnTaut the Portial Mucosa Is inContact with the Mucosa ofTHE Canal. INFECTIONS OF THE VULVA, VAGINA AND CERVIX 29 HP ,/^ [K4- y \M s 1 n m ^9^^V ■ B 1 ^r^^^^ * ) taHM am 1 / m Fig. 17.—A Silkworm Gut Stitch Is Next Passed, as per Diagram, Through THE PORTIAL MUCOSA AND INTO THE CanAL. 17). This suture is left in situ for three or four weeks, or until thepatient returns for her follow up examination, after her discharge fromthe hospital. The chromic gut suturesto either side, which have thus far actedas traction sutures, are now tied, bring-ing the gaping outer angles of the conedincision together, and completely con-trolling hemorrhage. With all suturestied, six in number (Fig. 18), the opera-tion is complete, and a small strip ofiodoform gauze drain is placed againstthe cervical stump, which is removed intwenty-four hours. Objection has been raised to thisprocedure on the ground that it is tooextensive for such a simple lesion, and that it may c
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Keywords: ., bookcentury1900, bookdecade1920, bookpublishernewyo, bookyear1921
