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But says that when academic writing services for graduate students come the successive ablation the edges, continued buy your research paper until reach perfectly healthy tissue, the knife far preferable the scissors for the preservation tissue. We endeavor, course, obtain broad, smooth, vascular edges, free from cicatricial tissue has therefore been disputed whether preferable freshen along the surface the vugina, and spare the vesical mucous membrane as much as possible the European method, Figs. Siencer Wells's Specula for Fistula Operations. or freshen perpendicularly from vagina bladder Simon. The former method will probably enable avoid vesical hemorrhages with greater sat essay writing help certainty.

custom research paper writers Hegar employs the flat funnel-shaped freshening when the edges still contain cicatricial tissue, claiming rather inconsequently that thus sacrifices less tissue than would if freshened perpendicularly outside the area scar tissue. It necessary before incising mark out with the point the scalpel the line incision upon the vaginal mucous membrane thus enabling keep at an even distance from the borders the fistula.

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In doing this must take into consideration the best direction cut, as to secure coaptation the edges.

The invaginated vesical mucous membrine which projects through the fistula must replaced and held back before the cutting begins. This may done a sponge attached a thread and passed into the bladder, or an assistant holding back the tissue means a sponge attached a sponge-holder. But the intro duction a good-sized catheter into the bladder will suffice crowd the fistula from the vesical side against the instruments the operator, and thus make the requisite tension. It will best, course, with small The lowest edge the fistula now transfixed about half an inch from the orifice, and the freshening the edges proceeded with evenly Hegar's Fistula-knives.

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Position the Uterus. HH, Near the uterus. Blh, Vesical neck. After Luschka. along the line marked out. Meanwhile the assistants carefully sponge and irrigate the wound with a, carbolic acid solution. Spurting arteries must either seized with an artery forceps, or twisted, or tied. There most danger from the large custom research paper service arteria vesico-uterina, which runs along the side the cervix uteri, and sometimes as thick as a crow-quill. If were cut, the threads the ligature might need help writing college application essay be passed out through the wound, Simon having proven that this does not necessarily disturb healing first intention. The smaller arteries which may cut will included in the subsequent stitches. There no doubt that the ureter may cut through whilst freshening the edges write my summary such a fistula, especially if large and laterally placed. It may recognized noticing the urine flow from a small orifice, into which a sound can easily passed for a considerable distance upwards and backwards.

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