Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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hra in the manner previously described, after which heendeavors to form the missing portion of the penile urethra. 500 SURGERY OF THE PENIS AND URETHRA. Before attempting to restore the urethra, a prehminary externalperineal urethrotomy is performed, and perineal drainage of urine ismaintained until success of the plastic work is assured. For the forma-tion of the penile urethra double flaps are required; these are takenfrom each side of the urethral groove. The flap that is to be uppermostis the one usually formed first. It is secured by making a three-sidedrectangular incision close to and parallel with the urethral furrow, thelength corresponding with the length of the portion of the urethra that isto be formed. This is illustrated by the line a h (Fig. 284) at the upperand lower ends of the incision; two short incisions are made at rightangles to the first by cutting hackivard away jrom, the urethral groove, asshown by the lines h c and a d (Fig. 284). This flap should be so broad
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Fig. 283.- -Becks Operation for Balanitic Hypospadias (Fowler).A, Urethra in position; B, sutures applied. that, when raised, it can be transposed to the line g h (Fig. 284). Theflap of the opposite side is cut in a similar manner, except that the three-sided rectangular incision is reversed, the two short upper incisions beingmade in an exactly opposite direction to the corresponding ones on theother side, represented by the lines e g and / h (Fig. 284), and carried farenough back so that when they are joined by the incision g h & flap willbe obtained that, when dissected up, will be equal to one and one-halftimes the diameter of the canal it is desired to form. After the flaps areformed it will be observed that the base of the lower flap, e fgh,lies directlyalong the edge of the new urethra, whereas the base of the other flap,ah c d,is some distance from the urethral groove. The flap e f g h is nowturned over so that the cutaneous surface presents downward and the MALFORMATIONS

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