The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy.

Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: The perineum : its anatomy, physiology, and methods of restoration after injury / by Henry O. Marcy. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    very thin lamina is removed from the entire thickness of the spur. This done, the two lingers in the rectum keeping up tension of the septum, a nearly semicircular incision is made on the anterior sur- face of the latter, and two or three lines from its inferior border. The upper lip of this incision is next to be seized by forceps, and separated by careful dissection from the deep layer for the space in length of six lines, and in the entire breadth of the septum. Thus two laminae are formed, one anterior or vaginal, the other posterior or rectal; the latter destined to continue in situ to close the rectum, the former to be drawn forward and fixed by its angles at the anterior part of the new perineum on each side. It will thus form an inclined plane, directed from behind forward, as a sort of valve, which will act with reference to the new perineum as the epiglottis does to the glottis; that is to say, it will prevent the fluids of the vagina coming in contact with the newly united parts. “ The vivisection of the two sides of the laceration is the next object. To do this a quadrilateral space, rather elongated antero- posteriorly, is to be circumscribed by the scalpel, from the vulva toward the anus, avoiding the mucous membrane of the vagina above and the skin below. In frout the incision must not pass beyond, nor yet stop short of the point where the posterior com- missure of the vulva naturally exists; behind, it should connect itself with the corresponding side of the pared edges of the spur; no portion not pared should exist between them. In general, this quadrilateral space should be an inch and a half long, by three- quarters of an inch wide. “ This space having been accurately pared, and bleeding having ceased, next comes the introduction of the sutures. The suture intended to close the rectum is the first introduced, by a curved needle carrying a double thread. The needle should pierce the skin to the left of the anterior margin of the anus, and from four to five lines from the edge of the wound, so that it may come out on the denuded border of the spur of the septum, at the distance of about two lines to the left of the central line ; it is then to be plunged into the same border, at an equal distance from the median line, and to be brought out at a point corresponding to that at which it was first inserted on the opposite side. By drawing this thread, the opposite pared edges are found to approach in the median line and thus close the rectum. This ligature thus drawn, being entrusted