. The Principles and practice of gynecology : for students and practitioners. 357, i^and G. Second Step.—The redundant part of the vaginal wall havingbeen removed, Figure 357, G; to extend the incisions on either side ofthe vaginal wound and remove the mucous and submucous structuresto either side of the uterus to ])oints a and b, Figure 358, being sureto reach the fascial structures, which are in direct connection with MAL-LUCATWNS OF THE UTKRIS. 641 the lower nuirgiii of the broad ligaments or the broad ligamentsthemselves. TiiiKi) Stei.—To introduce two silkworm gut or chromic catgutsutures
. The Principles and practice of gynecology : for students and practitioners. 357, i^and G. Second Step.—The redundant part of the vaginal wall havingbeen removed, Figure 357, G; to extend the incisions on either side ofthe vaginal wound and remove the mucous and submucous structuresto either side of the uterus to ])oints a and b, Figure 358, being sureto reach the fascial structures, which are in direct connection with MAL-LUCATWNS OF THE UTKRIS. 641 the lower nuirgiii of the broad ligaments or the broad ligamentsthemselves. TiiiKi) Stei.—To introduce two silkworm gut or chromic catgutsutures, as shown in Figure 358, a and b. These sutures when tiedwill draw the loose vaginal tissues and the broad ligament struct-ures on either side of the cervix in front of the cervix, so as tobring points a and h in front of the cervix and force the cervix backinto the hollow of the sacrum. Figures 358 and 359. FouKTii STi:r.—The two sutures at a and b, Figures 358 and 359,having been tied, additional interrupted sutures are introduced to unite Figure 360. Figure Figure 360.—Same as Figure 359, except the lateral margins of the vaginal wound have beenunited by means of interrupted sutnres from the region of the cervix uteri to the region of theurethra. From this point on the redundancy of the vaginal wall must be disposed by a line ofunion at right angles to the long axis of the vagina. The two tenacula, tt, are here shownmaking traction on the sides of the open portion of the wound. A suture is intn^duced, butnot tied, showing the manner in which the margins of this wound are to be approximated. Figure 361.—Same as Figure 360. All the sutures have been introduced and the operationis complete. the vaginal wound from side to side. The first of these sutures isbeing passed in Figure 358. This suturing is continued to a pointnear the urethra, when most of the redundant vaginal wall will havebeen taken up ; there will now remain the lower portion of the cysto-cele and
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectgynecology, bookyear1
