Identifier: americanpractic07brya (find matches)
Title: American practice of surgery ; a complete system of the science and art of surgery
Year: 1906 (1900s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914, ed Buck, Albert H. (Albert Henry), 1842-1922
Subjects: Surgery
Publisher: New York, W. Wood and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

View Book Page: Book Viewer
About This Book: Catalog Entry
View All Images: All Images From Book
Click here to view book online to see this illustration in context in a browseable online version of this book.

Text Appearing Before Image:
nd the entire fistula should be trimmedaway with scissors. The intestinal wall should then be dissected from itsanterior attachments for a distance of three-quarters of an inch above thefistula, and half an inch to each side. A flap, large enough to replace that por-tion of the floor of this organ which had been destroyed, is next dissected fromthe soft tissues on either side of the urethra. A steel sound (No. 30 French) 832 AMERICAN PRACTICE OF SURGERY. is now introduced into the bladder, and these flaps arc sutured together overit at a sUght tension. Secondary flaps are then taken outside of the first flapsand (nitirely surrounding them, making a sort of cuff to the first area sutured.(Fig. 336.) The edges of the rectal wall are sewed together in all their thick-ness with chromicized catgut, down to the external sphincter muscle, at whichpoint the mucous membrane is dissected loose, for a short distance to eachside, and drawn together by stitches which do not involve the muscle. The
Text Appearing After Image:
Fig. 336.—Tuttles Operation for Recto-Urethral Fistula; Second Stage. (Tuttle.) incision into the urethra is left unsutured beyond a point just below the siteof the fistulous opening. (Fig. 337.) A No. 12 soft-rubber catheter is intro-duced through the meatus into the bladder and is fastened there by adhesivestraps attached to the head of the penis. The anterior portion of the perinealincision is loosely packed with absorbent gauze, and a drainage tube of largesize is introduced into the rectum to facilitate the escape of gas. Tuttleadvises that the catheter should be retained in the bladder for from seven toten days, but in three of his cases it was found impossible to do this; never-theless, no serious results followed. In case the catheter should come out SURGICAL DISEASES OF THE ANUS AND RECTUM. 833 before the expiration of the time, great care should be exercised in reintroduc-ing it, lest it should reperforate the sutured wound. The instrument shouldbe passed from the meatus o

Note About Images