Plastic surgery; its principles and practice . rethra and the existing incision will create the small quadrilateral raw surface shown inFig. 295,2. Separate accurately the perineal mucous membrane from the skin,along the U-shaped line AA. A good way to do this is to take finescissors and clip away the thin crest that separates mucous membranefrom skin along the line AA. Note that this procedure must be carried HYPOSPADIAS 33^ forward only so far as to the point where the dotted lines meet theperineal urethra (Fig. 295,2 CC)- At this point the mucous membranemust be left and the de
Plastic surgery; its principles and practice . rethra and the existing incision will create the small quadrilateral raw surface shown inFig. 295,2. Separate accurately the perineal mucous membrane from the skin,along the U-shaped line AA. A good way to do this is to take finescissors and clip away the thin crest that separates mucous membranefrom skin along the line AA. Note that this procedure must be carried HYPOSPADIAS 33^ forward only so far as to the point where the dotted lines meet theperineal urethra (Fig. 295,2 CC)- At this point the mucous membranemust be left and the demarcation continued forward in the form of anincision along the dotted lines (CC). This is to obviate undue narrow-ing of the urethra, with which we are threatened at this spot. Theline of separation between urethra and other structures having beenthus laid down, dissect away all the skin intervening between AA andBB, as indicated by the shading in Fig. 295,3. This will leave a broadraw surface in the perineum, narrowing as it passes Fig. 296.—Russells operation for hypospadias, continued.—i. The glandular urethracompleted. The central flap of skin is separated: stitches are placed which will infold thecentral flaps to line the urethra, and cover it with skin. 2. The sutures tied and newurethra completed. The operator must now strike a hne for the lateral incisions thathave been already made in the penile portion. In doing this, he forthe first time seems, as it were, to leave the track and travel acrosscountry through, it may be, rather doubtful looking scrotal must just plan his incisions so as to make the junction of the penilewith the perineal urethra uniform in calibre with the rest. Althoughthis has been the only point in the procedure at which I have experiencedsome feeling of uncertainty, healing has been quite satisfactory in thispart in both my cases. The entire length of the new urethra has now been marked skin composing it is now to b
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