. Manual of operative surgery. h instruments or with thefingers. If a sponge or wipe of gauze is used over the tips of the finger the dissection ismore satisfactory. This constitutes gauze dissection. 48 754 VARICOCELE Step 4.—Bring the two venous stumps together and keep them together bya stitch or by tying the upper to the lower ligature. Step 5.—Close the wound with or without drainage. Remarks.—The incision is made at the level of the external abdominal ringbecause at this place (a) it is easy to isolate the cord, {b) it is very easy toapply dressings after the operation. On recovery, a su
. Manual of operative surgery. h instruments or with thefingers. If a sponge or wipe of gauze is used over the tips of the finger the dissection ismore satisfactory. This constitutes gauze dissection. 48 754 VARICOCELE Step 4.—Bring the two venous stumps together and keep them together bya stitch or by tying the upper to the lower ligature. Step 5.—Close the wound with or without drainage. Remarks.—The incision is made at the level of the external abdominal ringbecause at this place (a) it is easy to isolate the cord, {b) it is very easy toapply dressings after the operation. On recovery, a suspensory bandage ought to be worn for some junior surgeon may be warned that a hard swelling about the testicleusually persists for a few weeks after healing, which may alarm the patientunless he is warned of the possibility before hand. R. Franks Operation (Zent. f. Chir., iv, April, 1914).—Frank avoidsligation and resection of the veins with consequent fibrous degeneration ofthe parenchyma of the Fig. 917. Expose the fascia of the external oblique and the external inguinal ringexactly as in an operation for hernia. Strengthen the external inguinal ringwith a stout stitch. Do not divide the fascia propria or the tunica the testicle up out of the scrotum to the bottom of which it is attachedby the gubernaculum. Divide the gubernaculum between forceps; ligate thescrotal stump but leave the forceps atached to the testicular stump. Fromthe apneurosis of the external oblique reflect downwards a flap (pedicle at theexternal ring) 5 cm. (2 in.) long and 2-3 cm. {^iri}4r in.) wide. Suture thedistal end of the aponeurotic flap to the testicular stump of the gubernaculum(Fig. 917). The length of the fascial flap must be sufficient to support thetesticle in its physiological position just under the root of the penis. Reducethe testicle into the scrotum. Close the wound. The testicle now lies upsidedown in the scrotum. PART v.—THE SPINE CHAPT
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