Circular Amputation of the Cervix 639 



sion about equal on the upper and lower margins, the extent 

 of superfluous vaginal mucosa is ascertained. An approxi- 

 mately oval-shaped portion of the extra vaginal mucosa is 

 removed with scissors from each side and the margins ap- 

 posed with interrupted silk sutures, each of which should in- 

 For purely vaginal sutures silk or linen is best, but if the 

 suture penetrates the endocervix catgut should generally be 

 used. If proper coaptation of the parts is secured, healing 

 should occur by first intention, 

 elude a small portion of the underlying paracervical tissue. 



After the disinfection of the operative area with iodine, 

 the single pair of forceps which now retract the cervix are 

 released, allowing the organ to resume its normal position. 

 It is left undisturbed for a period of about two weeks, when 

 the vaginal sutures are removed and the surfaces touched 

 over with pure Lugol's solution of iodine. At this time, pro- 

 viding that the technic has been thorough and efficient, the 

 appearance of the mucosa of the cervix should be normal, 

 with but slight trace of the operative procedure. 



During the operation it will be found advantageous to 

 maintain a constant supply of 1/2 to 1 per cent, chlorazene 

 solution for the irrigation of the operative area. Capillary 

 hemorrhage should be almost completely controlled by the 

 use of adrenalin chloride. 



Circular amputation, although requiring considerably 

 more skill and effort on the part of the operator than other 

 methods of procedure used in the correction of refractory 

 cervicitis, gives the most satisfactory results of any technic 

 which the author has used. The patient is usually fit for 

 service within two to four weeks after operation, and it has 

 been my experience that, in the absence of coexisting com- 

 plications in other portions of the genital apparatus, con- 

 ception usually follows very promptly. In the presence of 

 other lesions of a severe nature in the genital tract, such as 

 would in themselves cause sterility of a more or less per- 

 manent character, a cervical operation is not usually ad- 

 visable. 



