Pathology and treatment of diseases of women . through the rectum and they are tied on the rectal mucous mem-brane, then the rectum and the vagina are stitched up one after theother. If the sutures from the rectum and vagina are introduced so thatthey interlock with each other at their deepest places, and the rectum isfinally closed, then only the lower portion of the introitus remains to bestitched in order to close the vagina completely. The wound-edgeswhich have to be united to form the raphe perinei, lie close together at PATHOLOGY OF THE VAGINA AND UTERUS 143 this stage of the operation a
Pathology and treatment of diseases of women . through the rectum and they are tied on the rectal mucous mem-brane, then the rectum and the vagina are stitched up one after theother. If the sutures from the rectum and vagina are introduced so thatthey interlock with each other at their deepest places, and the rectum isfinally closed, then only the lower portion of the introitus remains to bestitched in order to close the vagina completely. The wound-edgeswhich have to be united to form the raphe perinei, lie close together at PATHOLOGY OF THE VAGINA AND UTERUS 143 this stage of the operation and can be closed easily with superficialsutures through the external skin. One must pay attention so as not toleave any cavities in the depth of the wound. If the columna rugarum is surrounded by the scar, or if the lower endhas become detached, then the denudation must make allowance for thiscondition. Many different variations in the direction of the incision and stitcheshave been proposed. The attempt was made to avoid tying of the sutures. f P FlG. 84.—Suture of the Perineum after Finishing the Rectal Suture. on the rectal mucous membrane, and therefore a figure-of-eight stitchwas used, which is tied in the vagina itself. Heppner106 has woundmetal sutures to a figure-of-eight which were tied in the rectum andvagina. Then it was attempted to introduce the sutures only superfi-cially in the rectum and begin below the uppermost vaginal suture tointroduce in the rectum from the perineum, so that thereby the perineumand vagina would be closed. The methods of Hildebrandt107 and specified for the operation of recent perineal laceration resemblesthis procedure, the suture being introduced from the perineum. Theoblique tying of the wound-surfaces to be coaptated cannot be favorableto a union. 144 DISEASES OF WOMEN If the interrupted sutures are tied from the vagina, rectum, and peri-neum, then the septum becomes very narrow. The continuous catgutstitch avoids this disadv
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Keywords: ., bookcentury1900, bookdecade1, booksubjectgynecology, bookyear1912
