File:A text-book of gynaecological surgery (1911) (14762912744).jpg

Identifier: textbookofgynaec00berk (find matches)
Title: A text-book of gynaecological surgery
Year: 1911 (1910s)
Authors: Berkeley, Comyns, 1865-1946 Bonney, Victor, 1872-1953
Subjects: Gynecology Genitalia, Female
Publisher: New York : Funk and Wagnalls Company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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he raw surface left after the removal of thegrowth. Removal of inguinal glands.—In all cases of malig-nant disease of the vulva the inguinal glands on bothsides should be removed, whether enlarged or not. Someauthorities prefer to remove these glands from seven tofourteen days after the primary operation, but we our-selves think it is preferable, when possible, to finish theoperation at one sitting. The removal of the glands is best carried out afterthe vulva has been excised and all the bleeding-pointssecured. The leg on the side to be first dealt with having EXCISION OF VULVA 107 been extended, an incision should be made running up-wards and outwards parallel with Pouparts ligament andstarting from the upper part of the already denuded area.The skin-edges of this incision having been turned back, allthe soft tissues down to the aponeurosis, including of coursethe horizontal inguinal glands, should be dissected out inone piece, starting at the outer angle of the incision (Fig. 54).
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-Removing the inguinalglands. All bleeding-points having been secured, the inguinalincision should be closed with interrupted silkworm-gutsutures, after which the thigh is flexed, and the other sideis similarly dealt with. The patient being restored to the lithotomy position,the vulval wound is united in the manner previouslydescribed (Fig. 53). 108 GYNECOLOGICAL SURGERY Danger.—If the growth is large and the clitoris andlabia minora are affected, there may be some difficulty indissecting the mass away without injuring the urethra.It will be found safer in these circumstances to put abladder-sound into the urethra whilst the structures inits neighbourhood are being removed. There is also a danger in these cases that, if sloughingoccurs in the neighbourhood of the urethra, the resultingcontraction of the tissues round its orifice may result inserious difficulty with micturition. Dressing.—The vulval wound is covered with dry gauzeheld in position by a T-bandage. If the inguinal gla

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