File:Surgery, its principles and practice (1906) (14586768929).jpg

Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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on p. 489.After an interval of rest thesecond step is undertaken. Asa preliminary measure, whichassures the success of the plasticwork, perineal drainage shouldbe instituted and maintaineduntil union of the raw surfacesbrought into apposition to formthe new urethra has taken place.Duplay takes advantage of thefact that the cavernous bodies, instead of being firmly united, are usuallyjoined by a fibrous septum; thus, by depressing this septum by means of aglass rod or a catheter, the corpora cavernosa are brought into appositionand the cleft thus formed is utilized to form the floor and a portion of thesides of the new canal, the roof being constructed by approximating thedenuded margins of the corpora cavernosa by means of a modified quilledsuture. If the urethral furrow is very shallow or undeveloped, it be-comes necessary to construct a groove that will correspond in length tothe portion of the canal that is to be formed; it should be of sufficient*Amer. Text-Book G. U. Dis., p. 24.
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Fig. 285.—Epispadias. MALFORMATIONS OF THE URETHRA. 503 depth comfortably to accommodate a rubber catheter at least 15 mm. in circumference. To accomplish this a median incision should be made directly between the cavernous bodies, the length and depth of which should be sufficient, when ^ ^ the roof of the canal is constructed, - to form a commodious urethra. The urethral roof is formed bytaking a parallel rectangular stripof tissue, about one-fourth of aninch in width, from each side ofthe corpora cavernosa, and three-fourths of an inch from the mid-line of the dorsum of the penis, ex-tending from the apex of the glanspenis down to the epispadic open-ing. The denuded surfaces, to-gether with the points for sutures,are shown in Fig. 289. The rawsurfaces are now brought intoapposition by means of modifiedquilled sutures. For this purposea plate composed of lead or hardrubber or a section of catheter in which holes, one-fifth of an inch apart, have been pierced for the passage ofthe

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