b. Operative Procedure.
(1) Skin is taken from the abdomen or anterior thighs. The donor sites are
dressed in the routine manner with pressure dressings over nonadhesive gauze.
(2) A vaginal orifice is created by sharp dissection, and a molding is made
of dental compound or plastic shaped to size. Donor skin, is sutured over the mold, and
the mold is secured in the vaginal opening with sutures and pressure dressings.
2-21. TRACHELORRHAPHY
a. General. This operation involves removal of torn surfaces of the anterior and
posterior cervical lips and reconstruction of the cervical canal. It is done to treat deep
lacerations of a cervix (1) that is relatively free of infection and (2) in women past the
childbearing age.
b. Operative Procedure.
(1) The labia are retracted with Allis-Adair forceps or sutures. The cervix is
grasped with a Jacobs vulsellum forceps.
(2) The affected tissue of the exocervix is denuded with a knife. The flaps
are undermined by means of a knife and curved scissors. Bleeding vessels are
clamped and ligated. The mucosa is dissected from the cervix.
(3) A small distal portion of the cervical canal is coned to remove infected
tissue by means of a knife. Bleeding vessels are clamped and ligated with chromic gut
number2-0 ligatures.
(4) The denuded and coned areas are covered by suturing and mucosal
flaps of the exocervix transversely, using six to eight interrupted chromic gut number0
sutures swaged to 1/2-circle, trocar-point needles. Tissue forceps, hemostats, and
sponges on holders are needed. The sutures are placed in such a manner that the
fibromuscular tissue of the cervix is included, thereby eliminating dead space where a
hematoma may form and providing a complete reconstructed cervical canal.
(5) The wound is cleansed and dressings are applied and held in place with
a binder. A retention catheter may be introduced in the bladder.
2-22. REMOVAL OF PEDUNCULATED CERVICAL MYOMA
a. General. This operation involves the removal of a tumor by the snare method
or by dissection from the cervical canal with a knife (or with cold-knife conization).
Cervical polyps stem from the endocervical canal. They may vary in size and are soft,
red, and friable. Bleeding may result from the slightest trauma. Usually, the surgeon
performs an endometrial and endocervical curettage and a cytological smear is taken.
MD0928
2-20
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