630 Diseases of the Genital Organs 



that coaptation ceases. When the tear of the lip is very 

 long, it will not be found advisable to tie the first sutures 

 until several of them have been placed and it is ascertained 

 that the margins will not pucker. When a simple dilation 

 of the lips occurs, without trace of longitudinal laceration, 

 the lumen is narrowed by the excision of a wedge-shaped 

 segment from a convenient location in the circumference of 

 the lip. The piece excised must be of such size and shape 

 that, when the denuded surfaces are brought together, the 

 tissue relation is maintained and the organ is restored to as 

 nearly its normal appearance as possible. The segment is 

 best removed with right and left trachelorrhaphy scissors, 

 after which the wound is closed as previously described. 



Trachelectomy 



The term trachelectomy is used here to denote various de- 

 grees of cervical amputation. Different conditions of the 

 cervix call for a somewhat varied type of trachelectomy and 

 tracheoplasty. Before attempting trachelectomy, the oper- 

 ator should make himself thoroughly familiar with the nor- 

 mal structure of the cervix. The operation should accom- 

 plish the removal of all diseased cervical tissue and attain 

 as complete a tracheloplasty as possible. Care should al- 

 ways be taken to protect the healthy cervical tissue, espe- 

 cially the endocervical mucosa, from injury during the 

 operation. The operator should bear in mind that the cervi- 

 cal canal is normally very small and that, when there is any 

 considerable dilation in the presence of an inflammatory 

 process, that portion of the endocervical mucosa which lines 

 the dilated section must usually be considered as diseased. 

 Although it may not be apparent, in many cases there have 

 been destructive changes which render it physiologically 

 functionless. 



Excision of the Prolapsed Endocervical Fold 



The excision of the first fold, when seriously inflamed, is 

 frequently indicated. It should be performed only when the 

 inflammatory process is confined to the first fold and its 



