OPERATIONS FOR THE REPAIR OF COMPLETE LACERATION OF THE PERINEUM
Under the term colporrhaphy (suture of the vagina) is included any operation in which denudation and subsequent suturing of one or both walls of the vagina is carried out. Anterior colporrhaphy includes the various operations devised for cystocele; posterior colporrhaphy, the procedures carried out for incomplete rupture of the perineum (colpo-perineorrhaphy), prolapse of the pelvic floor, and to produce narrowing of the vagina.
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Fig. 30. Complete Laceration of the Perineum. (From a photograph.)
a, a'. Ends of torn sphincter ani. cli. Clitoris. l.i. Labium internum. m.v. Mons Veneris. p.c. Preputium clitoridis. sph. Sphincter ani. ur. Urethral orifice. |
The appearance of the parts in this condition is quite characteristic (Fig. 30); the laceration of the recto-vaginal septum appears as a triangular space with its apex upwards, its sides equal, and its base formed by the retracted sphincter ani ([Fig. 32]). The separated ends of the sphincter are seen as two slightly depressed circular spots at the base of each side of the isosceles triangle a, a'. The object of the operation is to adapt these two ends, repair the recto-vaginal rent, and re-form the perineal body. There is often much irregular scar tissue about the opening, which may cause additional difficulty at the operation.
Fig. 31. Long-handled sharp-pointed Scissors curved on the flat.
The instruments necessary are six Spencer Wells artery forceps, long dissecting forceps with hooked points, a pair of sharp-pointed angular and a pair of sharp-pointed curved scissors (see Fig. 31), flat curved needles and Schauta’s needle-holder ([Fig. 73]).
The preparatory treatment consists in regular gentle purgation daily for a week, dieting, rest in bed for three days, and antiseptic vaginal douches of lysol (1 drachm to the quart).
Operation. The patient is placed in the dorsal position on a Kelly’s pad, and after the usual purification, denudation is commenced. The skin over the circular depressions corresponding to the ends of the severed sphincter (Fig. 30, a, a') is seized with the dissecting forceps and slightly raised. This portion of skin on either side is removed by means of the scissors, thus baring the ends of the sphincter and opening up the cellular tissue.