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Vaginal wall plastic surgery
Last reviewed: 23.04.2024
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Anterior colborrhaphy
The vagina is exposed in the mirrors. The cervix is seized with bullet forceps and reduced to the entrance to the vagina. From the anterior wall of the vagina, an oval flap is cut out, the upper edge of which is 1-1.5 cm below the urethra, and the lower edge near the cervical passage to the vaginal vault.
If the surgeon enters the layer, then, pulling the upper edge of the flap with Kocher's clamps, the mucous membrane of the vagina is easily separated from the underlying tissues. Then on the wall of the vagina, knotty sutures are applied with absorbable suture material with the capture of the fascia of the bladder.
Technique for the operation when the bladder is lowered and the anterior wall of the vagina. The mucous membrane of the vagina is opened, retreating 1 cm from the external opening of the urethra, a linear cut before the transition of the vaginal wall to the cervix, is detached to the sides, the fascia of the bladder is exposed.
The bladder is separated from the cervix. Then suture his muscles with a few stitches with absorbable suture material. If necessary, a catheter is inserted into the urethra and the tissues in the urethral sphincter region are sewn. Then the fascia of the bladder is sewn in such a way that one part of it goes to the other. Free flaps of the vaginal wall are cut and knotted sutures are applied with absorbable suture material.
[Colpospereoplasty
The operation of colpoperineoplasty can be divided into several stages. At the first stage of the skin of the perineum and mucous membrane of the back wall of the vagina, a diamond-shaped flap is cut out, the size of which determines the height of the perineum that forms during the operation.
The entrance to the vagina must be passable for two fingers. Too high a crotch prevents normal sexual intercourse.
After the incision, the mucous membrane of the vagina is cut off from the underlying tissues and perineal muscles in the sides to the line of lateral incisions of the intended diamond-shaped flap.
After excision of the mucosa, a wound is formed, which looks like an irregular rhombus. At the bottom of it is the front wall of the ampoule of the rectum.
When removing the mucous membrane of the vagina, one should be careful not to injure the rectum, since, especially in the presence of scarring, its wall is intimately attached to the wall of the vagina, the mucosa of which is very thinned.
The second stage - levatoroplasty - can be carried out in two ways - without isolation and with the allocation of the legs of the leftist from the fascial bed. When the leftists are joined together with the fascia and the surrounding fiber, a fairly firm scar is formed, which ensures the normal function of the pelvic floor.
The leftists are exposed. A round and thick needle grasps the edges of the legs of the leftists on both sides in the upper part of the wound, the ends of the thread are taken to the clamp and pulled upward, while the edges of the legs of the leftists approach each other. The seam is not tied. Leaving 1-1.5 cm from the first seam, superimpose the second and then the third seam closer to the anus.
To separate the legs of the leftist, a fascia cut is made, and then the muscle is isolated from the fascial bed and stitched.
The third stage is to connect the edges of the mucous membrane of the vagina with the picking up of the underlying tissues by stringing them on the needle. The seam is applied starting from the upper corner of the wound. You can seam the Reverden to the place where the posterior spike of the perineum will be formed.
The fourth stage of the operation is the joining of the edges of the leftists by tying the previously imposed ligatures. The tying of the ligatures begins with the top ligature. If necessary, in order to avoid the formation of "empty spaces", additional seams are superimposed on the perineal wound.
The edges of the perineal skin wound are connected by a continuous intradermal suture with a resorbable suture material or separate nodular sutures.
Colpoperinsoplasty can be performed as an independent operation, but it is often combined with other interventions: anterior or medial colpporaphy, vaginal exterpiration of the uterus, etc. All operations that are performed on the omission and loss of the vagina and uterus, based on the etiological factor, should be completed plastic surgery of the pelvic floor muscles.
Removal of the bartholin gland cyst
Above the greatest convexity cysts make a cut of the skin for 2-3 cm. Then blunt and sharp iron is removed and removed. Produce a hemostasis, impose first immersion seams, and then thin seams absorbable suture material on the skin. The weld area is treated with an antiseptic.
In some cases, the disease becomes recurrent. After opening the abscess of the gland inflammation subsides, and she stops palpating. In these cases, a cross-section of the skin of the labia majora is made in the area of the gland. In this case, the capsule becomes visible and can be picked out.