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the Diagrammatic representation of stages of a section across Pfannenshtil: and — the place of a section; — a kosha and hypodermic cellulose are dissect to an aponeurosis; in — a section of an aponeurosis and its lengthening; — an otseparovyvaniye of an aponeurosis from the subject muscles.

PFANNENSHTILYA SECTION (H. J. Pfannenstiel, is mute. the gynecologist, 1862 — 1909) — suprapubic cosmetic cross section of skin, hypodermic cellulose and an aponeurosis at a laparotomy. Kyustner and Rapen (O. of E. Kustner, Raping in 1896 offered O. a suprapubic section, however this way did not gain distribution. It is mute. the gynecologist Pfannenshtil, having taken it as a basis and having eliminated his defects, «suprapubic cross section of a fascia» which received in ginekol offered in 1900 the. to practice broad use. Rubles carry out the item cross 2 — 3 cm above a pubic symphysis, in the form of the line which is slightly curved from top to bottom on the natural suprapubic fold passing on the upper bound of growth of pubic hair (fig., a). Skin and hypodermic cellulose are cut a scalpel on all thickness (fig., b); length of coal mine 8 — 10 cm and more. The aponeurosis is made an incision cross, the section is extended in both parties from the white line with curved scissors (fig., c), according to length of a skin section to the outer edge of direct muscles of a stomach. The top and bottom region of an aponeurosis is occupied clips (like Kokher or Mikulich) on the middle of a section and otseparovyvat from the subject muscles (fig., d) as much as possible up to a navel and on 1 — 2 cm down to a pubic symphysis. The aponeurosis separates from the subject muscle easily, except for area of the white line where there is more dense fascial commissure between vaginas of direct muscles; it should be separated by means of curved scissors. After that direct muscles easily separate and cut a parietal peritoneum longwise.

Thanks to good distensibility of direct muscles after introduction to an abdominal cavity of a mirror dilator access through which the surgeon can execute a necessary operative measure is got sufficient size. Upon termination of operation the parietal peritoneum and direct muscles of a stomach are sewn up, as at a slit. The aponeurosis is sewn up with a continuous suture or noose sutures from a catgut or capron, trying to obtain at the same time the correct contact of its edges, especially on the ends of a section, in that place where the aponeurosis is split on three leaves. Skin with hypodermic cellulose is usually sewn up, as at a slit. It is possible to apply a hypodermic continuous suture from a thin catgut. After healing of an operational wound the thin linear hem which is closed by hair turns out and substantially masks a suprapubic fold. The hem has no tendency to a calloused thickening and pigmentation. Postoperative hernias at the laparotomy which is carried out by means of a section according to Pfannenshtil are rare that is big advantage of this section before a middle slit.

See also Laparotomy .

Bibliography: Gruzdev V. S. Gynecology, M. — D., 1928; Lipman V. A course of gynecologic operations, the lane with it., L., 1928; Pfannenstiel H. Über die Vorteile der suprasymphysären Fas-cienquerschnitts für die gynäkologischen Koeliotomien, Samml. klin. Vortr., N 268 (Gynäk., N 97), S. 1735, Lpz., 1900.

T. E. St. Petersburg.