File:Pathology and treatment of diseases of women (1912) (14594948529).jpg

Identifier: pathologytreatme00mart (find matches)
Title: Pathology and treatment of diseases of women
Year: 1912 (1910s)
Authors: Martin, August Eduard, 1847- Jung, Ph. (Philipp Jacob), 1870-1918
Subjects: Gynecology Gynecology
Publisher: New York : Rebman company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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results, as experienceshows, by the formation of a recto-vaginal fistula. Then I circumcisethe remainder of the scar tissue. The edges are stretched by tenacu-lum-forceps, which are attached to the apex of the columna, to the lowerend of the nymphse, and finally where the edge of the anus is recognizedby the scar (Fig. 82). All cicatricial tissue is carefully removed withinthis outline. The beginning of the continuous suture is tied in the vagina at thecolumna rugarum. The first loop of the sutures is to lie in the septum.The assistant draws on the suture and thus expands the septum broadly.. PATHOLOGY OF THE VAGINA AND UTERUS 141 The bowel is closed by suturing, so the needle does not touch the mucousmembrane but penetrates close to it. I usually come out with the needleclose to the right edge in the rectum, then I stitch into the left close tothe mucous membrane, enclose a healthy mass of tissue and come out onthe left side about half a centimetre from the edge of the rectal mucous
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Fig. 82.—Suture of the Complete Perineal Laceration. Stretching of the wound edges and denudation. membrane. The needle is reintroduced close to this stitch on the leftside, runs beneath the wound-surface to the right and is brought outagain. It reenters close to this point, that is, on the right side, to comeout at the edge of the wound in the mucous membrane (continuousmattress suture, Fig. 83) in its entire extent. 142 DISEASES OF WOMEN As soon as the rectum is closed down to the anus, the first row ofstitches is made by the same suture running backward, that is from theperineum on upward into the recto-vaginal septum to the upper wound-angle. If this row of sutures is sufficient for the coaptation of thewound-surfaces then the edges of the vaginal mucous membrane arecoaptated and finally the skin incision in the perineum is closed (Fig.84). If the wound-surfaces are too extensive, then a second row of

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