Gynecology . certain amount of mucus and blood is dammed back into the vagina, becomesfoully infected, and produces dire results. In order to leave the vagina in apermanently normal condition the occluding membrane should be completelydissected out and the wound edges approximated with great care. Such a woundwill heal by first intention, even in the face of a badly septic discharge. Thedetails of the operation for dissecting out an occluding membrane are as fol-lows: 566 GYNECOLOGY After the septum has been incised and the contents of the space beyond havebeen removed, there should be a thoro
Gynecology . certain amount of mucus and blood is dammed back into the vagina, becomesfoully infected, and produces dire results. In order to leave the vagina in apermanently normal condition the occluding membrane should be completelydissected out and the wound edges approximated with great care. Such a woundwill heal by first intention, even in the face of a badly septic discharge. Thedetails of the operation for dissecting out an occluding membrane are as fol-lows: 566 GYNECOLOGY After the septum has been incised and the contents of the space beyond havebeen removed, there should be a thorough cleansing of the parts, as statedabove. The edges of the septum should then be trimmed flush with the wallsof the vagina (Fig. 264). All scar-tissue should be removed so as to prevent afuture contraction. When the septum has been completely cleared away itwill be found that there remains a denuded area which extends like a ring aroundthe inner circumference of the vagina. The mucous membrane of the upper. Fig. 265.—Acquired Atresia of the Vagina. The transverse septum has been dissected out and the upper portion of the mucous membrane of the vagina united to the lower by interrupted catgut sutures. portion of the vagina is then drawn down and approximated to that of thelower portion by interrupted catgut sutures (Fig. 265). Such an operationshould restore perfectly the normal caliber of the vagina, and is not followed bya tendency to the development of a stricture. The use of antiseptic douchestwice or three times daily is begun the day after the operation, and should bekept up until the discharge completely disappears. OPERATIONS ON THE VAGINA 567 OPERATIONS FOR ABSENCE OF VAGINA The creation of an artificial vagina may be done either by the method ofemploying a loop of gut or by the turning in of skin-flaps from the surroundingparts. A technic devised and employed successfully by the author in one case isas follows: The patient is placed in the perineal position. A supe
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