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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    the vaginal end exposed. Each side is then cut oft near its juncture and withdrawn.” The object of this support is to do away with the distoition and puckering of tissue inherent to the deep wire suture, and prevent all strain upon the enclosed freshened surfaces. In this paper I also emphasize the fact that, in cases of complete rupture, I divide the refreshened sides of the rent laterally, and close with a continuous animal suture, so as to make the double V, or diamond Q shape of the parts to be coapted, as in incomplete rupture. At the Eighth International Medical Congress, held in August, 1S84, at Copenhagen, I contributed a paper still further setting forth the views I then held, and, with slight modifications, advo- cated the above described method, using tendon from the tail of the kangaroo instead of catgut. In May, 1887,' I published a further contribution to the study of perineal injuries and the restoration of the pelvic floor. In this article I advocate a modification in the dissection, in that I carefully find and separate the posterior third of the vagina, not its mucous membrane, from the more or less deformed perineal structures. “My dissection is to separate the vaginal muscle from its pathological relations, and is continued so as to reach the lateral sulci, and, in its closure, not only is intended to, but does overcome the patulous condition of the iutroitus vaginae in cases of great relaxation A curved needle, threaded with tendon or catgut, is introduced into the bottom of the wound, and then it is carried carefully, in deep suture, from opposite sides of the lateral sulci, behind the vagina. The posterior vaginal space being thus approximated, the same suture is continued deeply into the retracted ends of the trausversus perinei, and tied without extend- ing externally. This, of course, is intended to remain as a buried suture, and subsequent success is dependent upon its aseptic condi- tion. More recently, I have threaded each end of the tendon, and introduced the needles from opposite sides, thus making a double stitch. . . . In a number of hospital cases well selected, the patients under careful supervision, I have omitted the pins, trusting to the dee]) buried suturing. At present, I do not feel safe in com- mending this practice generally, but if trustworthy, it will be a manifest gain to both patient and surgeon.” 1 The Physician and Surgeon, vol. ix. Nos. 5 and S.