Trachelorrhaphy 629 



through the opposite margin of the laceration. This suture, 

 tied firmly on the posterior margin of the os, prevents gap- 

 ing of the lips. 



Care should be taken that none of the sutures penetrate 

 the endocervical mucosa because, should this occur, they will 

 not become buried and a complete healing of the endocervi- 

 cal mucosa by first intention can not occur. If the sutures 

 are properly placed they may be removed after ten to fifteen 

 days without injury to the endocervix. It is important to 

 bear in mind also, in the attainment of correct coaptation of 

 surfaces, that the margins of the laceration must be smooth 

 and straight and that a puckering of the opposing margins 

 must be prevented. 



The fibro-muscular tissue of the cervix is very tough, and 

 sometimes difficult to penetrate. When suturing this tissue, 

 a very strong needle with a sharp cutting point is required. 

 Ferguson's abdominal needles, Dibrell's needles, and Dr. 

 Howard Crutcher's perineum needle have been found to be 

 well adapted for this. 



When it is desired to use the perineal needle, it should be 

 threaded with one end of the suture quite short and passed 

 from the inside, between the endocervical mucosa and fibro- 

 muscular tissue, outward through the latter and the vaginal 

 mucosa. The short end of the suture is now caught and the 

 needle, still threaded, is withdrawn and passed in the same 

 manner through the opposite margin of the laceration, 

 whence it is withdrawn unthreaded. 



Lacerations through the fibrous structure of the cervix 

 cause a gaping, of the wound, to control which the sutures, 

 as above described, are subject to considerable tension. A 

 non-elastic suture such as braided silk is usually the most 

 suitable. The size of the suture material should be such 

 that the desired parts can be firmly and permanently 

 brought into apposition. For the posterior margin of the 

 lips heavier suture material than for the other portions, 

 usually No. 4 to No. 8 braided silk, is used. Catgut used 

 in this region is generally very unsatisfactory, as its elas- 

 ticity permits the apposed margins to separate sufficiently 



