Orificial Surgery Its Philosophy Application And Technique

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and the transversus perinei muscles, but only two or three stitches are necessary and these should not include the skin. The needle should enter the wounded surface close to the margin of the skin upon one side, pass through the extremities of the mus- cles to be reunited, and find its exit close to the skin on the op- posite side, so as to avoid skin impingement. Subcutaneous stitching can be relied upon for the surface coaptation. One reason for failure to secure satisfactory results in the A...merican operation is that the stitching employed is not only of the variety of skin puncturing and pinching, which we have al- ready considered, but that the stitches are frequently so deep as to pierce the fibers of the external sphincter muscle, there- by inducing spasmodic contraction of the same and tearing the ma 'gins of the wound apart or, in cases where healing takes place, inducing a clumsy and strictured condition which requires subsequent correction. Subcutaneous stitching prac- tically solves the only remaining problem of the American operation and robs it of its terrors.

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