Recent improvements in the operative treatment of vesico-vaginal fistula / by J. Clarence Webster.

  • John Clarence Webster
Date:
[1895]
Catalogue details

Licence: Public Domain Mark

Credit: Recent improvements in the operative treatment of vesico-vaginal fistula / by J. Clarence Webster. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Winckel,1 however, in an important paper, which he published in 1891, highly recommending this new method, showed that such a step was unnecessary. If the vesical flap be now pushed inwards, and the vaginal flap pulled outwards, it will be seen that a large raw surface exists all around the fistula. Sutures are now applied. Walcher brought the vesical flaps together with catgut, and the vaginal flaps with silk. This is not necessary. Catgut alone may be employed either by the continuous method or by separate sutures. In either case a deep series should be first passed, each one entering the raw tissue just inside the edge of the vaginal mucosa, and emerging close to the vesical mucosa. Afterwards a superficial set should be used to close the edges of the vaginal mucosa. In certain cases, if it be feared that the tension of the stitches is excessive, a simple means of relieving it may be adopted. Before the sutures are applied, a longitudinal incision \ in. or | in. in length may be made through the mucosa of the anterior vaginal wall, somewhere near the outer border of the wall. As a result of this incision, the vaginal flaps at the edge of the fistula may be more readily approximated. This may be carried out on both sides, if necessary. After the closure of the fistula, these lateral incisions, which have been made to gape, may be closed more or less thoroughly, the sutures being passed at right angles to the original incision. 3. Large fistulce, in which there has been some loss of tissue. When the fistula is large, and its edges cannot be approxi- mated owing to the loss of tissue which has occurred, it is use- less to attempt its closure by the Sims method or even by <Udoublement. For such cases the following method may be tried. It has been described by Professor Ferguson of Chicago, in the American Journal of Obstetrics for April 1895. It was, however, first employed and recommended by Martin of Berlin 1 Miinchen. med. Wchnschr., 1891, No. 31. In the Ztschr. f, Geburtsh. u. Gyniik., Stuttgart, bd. xxx. heft 2, Winckel has again insisted upon the import- ance of this flap-method.
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