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The second step of the operation is to introduce the sutures of silkworm gut. The two fingers are removed from the rectum and well cleaned. The point of the handled needle is introduced at the upper angle of the wound (No. 2 in Fig. 21) without penetrating the skin or vaginal mucous membrane, carried along about one-half inch from the distal edge of the vaginal flap and made to emerge at the median raphe. It is then threaded and drawn out. The point of the needle is again introduced at the upper angle of the wound on the opposite side (No. 4 in Fig. 21), forced along the distal edge of the flap about one-half inch from the edge and made to emerge again on the median line. It is threaded and drawn out. This constitutes the first suture. Generally three anterior sutures are introduced in the above manner. To
ROBINSON B. COLPOPERINEORRHAPHY AND THE STRUCTURES INVOLVED.. JAMA. 1898;XXXI(16):921-925. doi:10.1001/jama.1898.92450160040002p