. The Principles and practice of gynecology : for students and practitioners. Incised wounds on both sides of the fistula closed at right angles to lines of incision. Theedges of the fistula now readily fall into apposition. Sutures foi closure of fistula in place, andtwo of them tied. The Operation for Closing the Fistula.—This involves a con-sideration of the following topics : 1. General preparatory treatment, 2. Choice of speculum and method of operation. 688 TBAVMATISMS. 3. Choice of direction for closure of the fistula. 4. Denudation. 5. Introduction of sutures. 6. After-treatment. 1. Th
. The Principles and practice of gynecology : for students and practitioners. Incised wounds on both sides of the fistula closed at right angles to lines of incision. Theedges of the fistula now readily fall into apposition. Sutures foi closure of fistula in place, andtwo of them tied. The Operation for Closing the Fistula.—This involves a con-sideration of the following topics : 1. General preparatory treatment, 2. Choice of speculum and method of operation. 688 TBAVMATISMS. 3. Choice of direction for closure of the fistula. 4. Denudation. 5. Introduction of sutures. 6. After-treatment. 1. The General Preparatory Treatment and arrangements for plastic operations described in Chapter II. are applicable and adequate for this operation. Figure The use of the uterine tenaculum and Emmets scissors in denudation. Left lateroproneposition; exposure by Sims speculum. 2. Choice of Speculum and Method of Operation.—The authorschoice between the method of Simon, with the patient in the dorsalposition, the parts being exposed by numerous vaginal retractors, andthe method of Sims, with the left lateroprone position and Simsspeculum, is based upon an extensive experience with both Simon method is serviceable and adequate for the ordinary case,but not always for difficult cases. This is especially true when thefistula is near the vaginal outlet behind the ramus of the pubes. Infat subjects, moreover, the Sims position and speculum are almost GENITAL FISTULA. 589 indispensable. Decided preference therefore is given to the methodof Sims as taught and practised by Emmet. The position of thepatient and the use of the speculum are described in Ciiaptcr JIJ. 3. Direction of the Line of Union.—In order to decide n])on theexact
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