. A manual of gynæcology and pelvic surgery, for students and practitioners. oon as a retractor and light reflector. dominal cavity. Special needles for cervical repair are of nogreat advantage, but no abdominal operation should be under-taken without a sufficient number of small round needles forpossible work upon the intestine. The author has devised a modification of the well-known INCISIONS 583 Becks spoon by broadening the blade, lessening its concavity,and turning the handle away from the blade at an angle of45 degrees, which renders it an excellent intra-abdominalretractor and an effici
. A manual of gynæcology and pelvic surgery, for students and practitioners. oon as a retractor and light reflector. dominal cavity. Special needles for cervical repair are of nogreat advantage, but no abdominal operation should be under-taken without a sufficient number of small round needles forpossible work upon the intestine. The author has devised a modification of the well-known INCISIONS 583 Becks spoon by broadening the blade, lessening its concavity,and turning the handle away from the blade at an angle of45 degrees, which renders it an excellent intra-abdominalretractor and an efficient light reflector as well. Clamps withdetachable handles, such as those devised by Pryor, are veryuseful if vaginal hysterectomy is to be performed by the clampmethod. While a sufficient number of the instruments required shouldalways be at hand, a multiplicity of special instruments, devisedfor every possible contingency, is not advised. INCISIONS The object of the abdominal incision is to secure an avenue ofapproach to the structures to be dealt with and no other con-. FiG. 258.—Line of transverse abdominal incision. Devised by Pfannenstiel. sideration is of equal importance, but the factors of injury tomuscles, fascia, and nerves should be taken into account, aswell as the possibility of accurate suturing at the close of theoperation proper. A crescentic incision, concavity upward,through the skin and superficial fascia at or below the superiormargin of the mons pubis, followed by dissection of the flap,a transverse fascial incision, and a longitudinal incision throughthe peritoneum, is favored by many. This presents no ad- 584 GYNECOLOGIC SURGERY vantage save the avoidance of a skin scar, and it seriously re-stricts the working space in the event that unexpected diflS-culties are encountered. In selected cases, however, this in-cision devised by Pfannenstiel gives a remarkably aestheticresult. The best all around incision for pelvic work is a median skinincision whose
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