Gynaecology for students and practitioners . ough the musculo-fascial layer and alsomade to take a deep hold of the exposed anterior cervical wall, so thatwhen tied the edges of the muscle are held in contact with the cervix,and no interval remains through which the bladder might againbecome pushed down. The fourth stitch .(shown in Fig. 484) is onlyoccasionally required ; it takes up the cellular tissues at the sides of thecervix corresponding to the lowest parts of the broad ligaments andunites them in front of the cervix. When elongation of the cervixis present, the lower portion may at thi
Gynaecology for students and practitioners . ough the musculo-fascial layer and alsomade to take a deep hold of the exposed anterior cervical wall, so thatwhen tied the edges of the muscle are held in contact with the cervix,and no interval remains through which the bladder might againbecome pushed down. The fourth stitch .(shown in Fig. 484) is onlyoccasionally required ; it takes up the cellular tissues at the sides of thecervix corresponding to the lowest parts of the broad ligaments andunites them in front of the cervix. When elongation of the cervixis present, the lower portion may at this stage be amputated, andthe operation is then completed as follows ; 812 GYNECOLOGY Step IV. The redundant portions of the vaginal flaps are nowcut away, and the edges united with a running stitch or with inter-rupted sutures, beginning at the cervix and ending just below theurinary meatus {see Fig. 485). The anterior vaginal wall is then swabbed freely with tincture ofiodine, and the vaginal canal loosely packed with sterile gauze. If the. Fig. 486. Perineorrhaphy for Incomplete Laceration. The dottedline shows the first incision. perineum is deficient, perineorrhaphy should also be performed, inorder to afford the bladder additional support. Perineorrhaphy. This procedure is a plastic operation for the secon-dary repair of obstetric injuries of the perineum and of the posteriorvaginal wall. The operation required for the primary immediaterepair of such injuries is described in textbooks of midwifery. Incases where the primary operation has failed, secondary repair shouldnot be undertaken for at least six weeks, this interval being requiredto allow the natural processes of involution to be completed,, and anylocal infection which may be present to be cleared up. PLASTIC OPERATIONS 813 The extent of the operation varies according to the local conditionspresent. An extensive laceration laying open nearly the whole of theanal canal may be seen {see Fig. 495, p. 820), or the cond
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
