. Gynecology : . orm of a racquet, the upper edges of the outer wound being approximated 584 GYNECOLOGY from side to side down to the point of the wound just above the meatus. Atthis point the edges of the outer and inner wound are Sometimes the excision of the vulva is necessarily so extensive that variousplastic maneuvers must be resorted to. If the vaginal mucous membrane cannot easily be approximated to the edgeof the skin wound, the vagina can be freed for a short distance and thus bebrought down more easily. In operating for cancer of the vulva it is often necessary to mak
. Gynecology : . orm of a racquet, the upper edges of the outer wound being approximated 584 GYNECOLOGY from side to side down to the point of the wound just above the meatus. Atthis point the edges of the outer and inner wound are Sometimes the excision of the vulva is necessarily so extensive that variousplastic maneuvers must be resorted to. If the vaginal mucous membrane cannot easily be approximated to the edgeof the skin wound, the vagina can be freed for a short distance and thus bebrought down more easily. In operating for cancer of the vulva it is often necessary to make so wide adissection out on the skin that the method of approximation above describedis not feasible. The classical plastic device for overcoming this difficulty is tomake a wide triangular incision with the apex toward the thighs. The tri-angular area of skin included within the lines of incision is somewhat looselyattached and can easily be slid inward toward thevagina. The wound edgescan then be Fig. 214.—Bassets Operation for Cancer of the Vulva. The Incision. Basset performs the complete operation at one sitting. We recommend Taussigs method of dissecting the inguinal regions first and performing a vulvectomy at a later operation. SPECIAL OPERATION FOR CANCER OF VULVA The best method for operating on cancer of the vulva is that recommendedby Taussig. He divides the operation into two stages, the first being a dissectionof the two inguinal regions, and the second, performed sometime later, a removal OPERATIONS ON THE VULVA 585 of the primary cancer mass. The two-stage operation is especially advisable be-cause it is impossible to secure first intention healing from the vulvectomy wound,and if the inguinal regions have been dissected at the same time they are almostsure to be infected from the vulvar area. This results in an enormous gapingwound which requires weeks of granulation and slow healing. The dissection of the inguinal regions is carried out by th
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