Texas State Journal of Medicine

Cover Texas State Journal of Medicine
Texas State Journal of Medicine
Texas Medical Association
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It is very redundant and is attached to the muscularis beneath by very loose are- olar tissue which allows it to glide freely in any direction; its transverse folds allow it to be brought down to an unexpected de- gree. Longitudinal folds are found only in the anal canal for from about 1 to 1^/4 inches. Separation of this mucosa is diffi- cult only in the anal canal. For easy dissec- tion one should start above the anal canal, where the fascial plane of the mucosa is easily determined, and diss...ect downward through the canal. In this way hemorrhage is also lessened. Complete incision of the sphincters opens the way for such dissec- tion. It is desirable to dissect first and most at the back and sides, where nearly all internal openings of fistulous tracts are found. The attachment of the anal canal is more intimate in front, behind the trian- gular ligament, than at any other point.
For this reason any necessary anterior dis- section should be finished last, care being taken not to go above the prostate, nor deeper than the thumb's length, for fear of wounding the vesico-rectal pouch, should the muscularis be penetrated.


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