Volume 2

A manual of operative surgery / by Frederick Treves.

  • Treves, Frederick, 1853-1923.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: A manual of operative surgery / by Frederick Treves. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    125/808 (page 105)
    Comment.—This operation meets successfully with the two great difficulties which attended early procedures. 1. In these cases a sinus was left at the site of the umbilicus which it was found almost impossible to close. Such a result may be certainly expected if lateral flaps are employed in the fresh state without reversion or without the addition of the umbilical flap. 2. The constant pressure upon the posterior A^all of the bladder had in the early cases a tendency to cause a protrusion as the cicatrices contracted. As a result of this the opening above the penis became larger and larger. This difficulty is met partly by groin flaps of considerable size, which closely embrace the root of the penis, and partly by means of the scrotal flap, which prevents the tissues about the opening from being drawn up as cicatrisation and contraction proceed. The scrotal flap is an es- sential feature in dealing with the epispadias. During the progress of the operation all the antiseptic washes or lo- tions used should be warm. In dissecting up the lateral flaps great care must be taken in cases where inguinal her- nial exist. If it be possible so to fashion the pedicles of the inguinal flaps that the external pudic arteries are not divided, a great point is gained. Modifications of Wood's Operation.—Mr. Greig Smith, of Bristol (Brit. Med. Journal, Feb., 1880), makes the flaps of a little larger size. The umbilical flap is in shape like the wooden portion of a fire-bellows. The portion corresponding to the handle of the bellows is uppermost and in the median line, and when the flap is turned down this portion is used Fig. 298.—•wood's operation fob ectopia VESICAE. A, b, Lateral flaps ; e, Upper flap ; P, Prostate ; p, Penis.