. The diagnosis and treatment of diseases of women. ay continue to prove troublesome even after the suture are passed and some cases, after such operation, blood clots have formed in the bladder to suchan extent that the wound had to be reopened. The sutures are passed as shown in Fig. enter the vaginal mucosa x to y an inchfrom the margin of the denuded area, passinto the bladder sub-mucosa, emerge near thebottom of the denuded area and then passthrough corresponding tissues on the oppositeside of the wound. They do not appear onthe vesical surface. The sutures are passed at
. The diagnosis and treatment of diseases of women. ay continue to prove troublesome even after the suture are passed and some cases, after such operation, blood clots have formed in the bladder to suchan extent that the wound had to be reopened. The sutures are passed as shown in Fig. enter the vaginal mucosa x to y an inchfrom the margin of the denuded area, passinto the bladder sub-mucosa, emerge near thebottom of the denuded area and then passthrough corresponding tissues on the oppositeside of the wound. They do not appear onthe vesical surface. The sutures are passed at intervals of aboutFig. 525. The Course of the Needle one-fourth of an iuch. They may consist of in suturing a vesico-vaginal fistula, v. „ , a rx Vaginal surface, b. Bladder surface. silkworm-gut Or ol 20-day catgut. Alter theThe needle passes to, but does not in- sutures are passed the bladder should be washed elude, the bladder mucosa. (Skene— ,„ ,^ i-ij_ i i Diseases of Women.) out Dei Ore they are tied, to wash out all blood. TREATMENT OF VESICO-VAGINAL 515 from it. The sutures are then tied and cut, and, if desired, the bladder may befilled with boric acid solution (3%) to see if there is any leakage. It is preferable in most cases to first close the deeper portions of the woiuid withburied sutures, as shown in Fig. 526. A very useful expedient, especially when there is much loss of tissue and decidedtension in bringing the sides together, is to incise the vaginal surface around thefistula, as shown in Fig. 527, and then turn in the edges without cutting any raw surfaces of the turned-in flapsare sutured together by buried sutures(Fig. 528) and then the vaginal mucosa isclosed over by continuous or interruptedsuture as desired (Fig. 528). After the fistula is sutured, a lightpacking of antiseptic gauze is placed inthe vagina, the soft-rubber retentioncatheter is introduced, if it is to be used, adressing is apphed over the vulva andthe patient is p
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