Operative gynecology : . cyst, which is rapidly dissected free on all sides. The dissection cysts of Bartholins glands. 253 must be slowly and carefully made on its inner side to avoid cutting throughthe thin mucous surface. It is best not to rupture the cyst in enucleation, soas to prevent the escape of its contents over the wound, as well as to avoidthe difficulty of finding and removing all parts of the cyst walls. After themore exposed part has been freed, the cyst must be gently drawn to one side andthen to the other with the fingers, while the posterior surface is freed. Thecyst must not
Operative gynecology : . cyst, which is rapidly dissected free on all sides. The dissection cysts of Bartholins glands. 253 must be slowly and carefully made on its inner side to avoid cutting throughthe thin mucous surface. It is best not to rupture the cyst in enucleation, soas to prevent the escape of its contents over the wound, as well as to avoidthe difficulty of finding and removing all parts of the cyst walls. After themore exposed part has been freed, the cyst must be gently drawn to one side andthen to the other with the fingers, while the posterior surface is freed. Thecyst must not be grasped with forceps for fear of rupturing it. The hemor-rhage from numerous small vessels is controlled by the stream of water con-stantly running over the field. When the vulvo-vaginal duct is cut, the con-tents of the tumor often begin to exude by the fine orifice. The removal of the cyst leaves a deep bleeding cavity in the labium. Allpersistently bleeding vessels are caught and tied with fine catgut. Neglect of. Fig. 137.—Left Vulvo-vaginal Gland excised and the Wound closed with Five Interrupted Catgut Sutures. this precaution will result in the formation of a blood tumor of considerablesize; I have seen one such- hematoma containing 90 cubic cm. (3 ounces) ofblood, and the overflow into the patients bed was estimated at an additionalliter. The pulse, which had been normal, went up to 150. A profound anemiaresulted. After checking the bleeding, interrupted silkworm gut or silk suturesare passed on the skin surface, the loop of each suture reaching to the bottom 254 DISEASES OF THE EXTERNAL GENITALS. of the wound and bringing the surfaces together, leaving no pockets for theaccumulation of blood. The usual dry dressing is placed on the surface, andthe sutures are removed in a week. A detailed report of the cases of cysts of Bartholins gland which cameunder observation at the Johns Hopkins Hospital during the years between1893 and 1903 has been recently published by m
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