628 Diseases of the Getiital Organs 



ing of the lips with a partial eversion of the first fold, or, 

 if this fold becomes inflamed, a severe ectropia results. It 

 is of considerable importance that the normal tissue rela- 

 tions be maintained or restored, since upon this is depend- 

 ent to a great extent the future health and physiological fit- 

 ness of the utero-cervical canal. 



The cervix is retracted, as in the former case, well into 

 the vaginal introitus and tenaculum forceps placed on either 

 side of the laceration. The margins of the wound are de- 

 nuded, taking care that fresh surfaces are left in each layer 

 of mucosa and in the fibro-muscular layer between. All 

 cicatricial tissue is removed. The surfaces denuded must 

 be left smooth and even in order to attain a satisfactory 

 coaptation. When making the denudation, trachelorrhaphy 

 scissors are found very helpful. 



The denuded area on each side presents an inner layer of 

 endocervical mucosa, an outer layer of vaginal mucosa and, 

 between these, the dense fibro-muscular tissue. A correct 

 coaptation of mucosa to mucosa must be obtained. Begin- 

 ning at the anterior commissure of the wound, interrupted 

 sutures are placed at intervals of about one-quarter inch. 

 These are inserted by directing the needle inward through 

 the vaginal mucosa near its margin on one side, and, after' 

 penetrating deeply into the fibro-muscular tissue, bringing 

 it out at the margin of the endocervical mucosa without 

 penetrating it. This order is reversed on the other side of 

 the laceration. The suture is tied firmly and cut off, leaving 

 an inch or two of its end so that it may be readily picked up 

 at a later date for removal. The sutures are thus continued, 

 at about one-quarter inch intervals to within about one-half 

 to three-quarters of an inch from the posterior margin of 

 the lips, where one suture is placed at right angles to the 

 preceding : that is, piercing the mucosa of the posterior edge 

 of the lip about one-eighth inch from the edge of the wound, 

 the needle is directed, anteriorly, deeply into the fibro-mus- 

 cular tissue, and emerges midway between the endocervical 

 and vaginal mucosa about one-half to three-quarters inch 

 anterior to the os. It is passed then in the reverse order 



