Identifier: gynecologygrav2 (find matches)
Title: Gynecology
Year: 1916 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia and London : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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chnic is that only one catgut knot isleft exposed and is in a position where it can do little harm. This is an im-portant factor in the avoidance of postoperative adhesions. In sewing up the abdominal wound after an operation in the Trendelenburgposition the patient should be returned to the horizontal position before theskin and fat are sutured. It will be found in most cases when this is done that HYSTERECTOMY OPERATIONS 623 on account of the change in position a little bleeding takes place from thesubcutaneous vessels which require tying. If this precaution is not taken itwill happen occasionally that the skin sutures will not control this adventitiousbleeding, and a blood-clot will form in the wound which may cause delay inthe convalescence. Vaginal Drainage.—Whenever drainage of the pelvis is necessary it shouldbe made, if possible, through the vagina. Abdominal drainage should be resortedto only in the most severe inflammatory cases, or when the posterior culdesac Z&labber
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\\( .P. Graces- Fig. 331.—Vaginal Drainage After Supravaginal Hysterectomy.The tips of the clamp in the vagina are seen just emerging through the opening in the posterior vaginal wall. is so occluded with adhesions that opening the vagina would entail too greatrisk of injuring the rectum. The method of instituting vaginal drainage during the operation of supra-vaginal hysterectomy is as follows: After the cervical stump has been closed and the uterine vessels have beentied, an assistant introduces into the vagina a long curved clamp with the tipturned toward the abdominal wound (Fig. 330). As the introduction of theclamp must be made under trie operating sheet covering the patient, the assist- 624 GYNECOLOGY ant must be careful not to enter the urethra instead of the vagina. The stumpof the cervix is drawn strongly upward and the ends of the clamps are pressedagainst the posterior vaginal wall near the cervix. The clamp is then unclaspedand the surgeon makes an incision between the

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