Identifier: plasticsurgeryit00davi (find matches)
Title: Plastic surgery; its principles and practice
Year: 1919 (1910s)
Authors: Davis, John Staige, 1866-1933
Subjects: Surgery, Plastic
Publisher: Philadelphia, P. Blakiston's son & co
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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so as to make the junction of the penilewith the perineal urethra uniform in calibre with the rest. Althoughthis has been the only point in the procedure at which I have experiencedsome feeling of uncertainty, healing has been quite satisfactory in thispart in both my cases. The entire length of the new urethra has now been marked out.The skin composing it is now to be carefully raised on either side, work-ing toward the median line, sufficiently to permit it to fold easily over zz^ PLASTIC SURGERY to make the new urethra, without the least tension. All is now readyfor the suturing. Fig. 296,1. The new urethra and the skin of the penis are nowbrought together throughout by a series of sutures. Each sutureincludes four layers of skin, the needle passing in order through outerskin and urethral skin of one side, then through the urethral skin andouter skin of the other. I need not dwell on the necessity for extremedelicacy and accuracy in the performance of this final step of the opera-
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FiG. 297.—Perineal hypospadias. Patient 24 years old. No. 5559.—The urethralopening is about on the level with the cross mark. The testicles are apparently normal.The scrotum is bifid and the penis which is markedly curved forward, is considerably smallerthan normal. tion on the penile portion of the urethra, which is the only part of theoperation in which the result is at all precarious. The perineal por-tion, where the surface is broad, scarcely needs any suturing; the suturesthere will, of course, just miss the mucous membrane. Fig. 296,2 shows the operation completed. The objection to this operation is that hair will probably grow onthe scrotal skin which is used to form the lower half of the urethra. HYPOSPADIAS 333 METHOD OF CHOICE I prefer Russells method of forming the glandular urethra, andhave done a number of cases in this way without a single failure. Itis somewhat difhcult to understand the application of the flaps, butonce understood, it is in my opinion the best met

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