File:The Cleveland medical journal (1910) (14586804937).jpg

Identifier: clevelandmedical09clev (find matches)
Title: The Cleveland medical journal
Year: 1910 (1910s)
Authors:
Subjects: Medicine Medicine
Publisher: Cleveland : The Cleveland Medical Journal Company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and the National Endowment for the Humanities

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Fig. 2 w hen patients were ready to leave the hospital, the infectionpresent) had progressed well toward recovery. The technic employed is as follows: The bladder is thor-oughly washed with a boracic solution and then filled with thesame before the patient is anesthetized. Nothing is inserted intothe rectum as is often done. The patient is placed in the Tren-delenburg position, a vertical or transverse incision is made, Lower—Closing the Urinary Bladder 709 depending upon whether or not there is much adipose tissue.After cutting through the sheath of the rectus and separatingthe muscle, the peritoneum is pushed out of the field and thebladder exposed extraperitoneally. A curved two pronged ten-aculum or bullet forceps catches the bladder on each side (asshown in Fig. 1), the bladder is lifted and an incision made longi-tudinally between the two tenacula into the bladder. The tenaculaare now removed and the edges of the bladder incision retracted
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Fig. 3 with small smooth retractors (if greater retraction is needed) butat no time, and this is most important, are the cut edges caught bya crushing forceps, e. g. like a hemostat. If this is done, it willbe impossible to get a close approximation of the cut edges.When the wound is ready for closure, a round, half curved needlethreaded with 00 chromic catgut is used, never linen or silk.Stones almost invariably form if the ligature is non-absorbable.The first suture is passed through the muscular coat down 710 The Cleveland Medical Journal to the mucosa (Fig. 2) and a free end is left long for traction; atenaculum is inserted at the other end of the opening and the cutstretched. The first row of sutures is then made parallel withthe cut muscles, never through the mucosa, and is drawn onlytightly enough to approximate nicely the cut edges. The next row of sutures (Fig. 3) is made transversely tothe cut and penetrates all the layers of the bladder except themucosa and is then tied to

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