Perineal Laceration Repair

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Presentation transcript:

Perineal Laceration Repair Cedar Rapids Medical Education Foundation 10/18/2010

Introduction One of the most common surgical procedure. Potential sequelae: 1. Hemorrhage or hematoma. 2. Chronic perineal pain. 3. Dyspareunia 4. Urinary and fecal incontinence.

Perineal Anatomy Perineal body Blood supply Nerve supply

Vaginal Hematoma

Perineal Laceration: Gradings First degree Second degree Third degree Fourth degree

Preparation Suture: Polyglactin 3-0 less assoc. with perineal pain and wound dehiscence. Anesthetic: 1% lidocaine, 10 cc syringe with 27 gauge 1.5 inch long needle. Instruments: Needle driver, suture scissors, toothed forceps, allis clamps, deaver/gelpi retractor. Strerile drapings/gloves/irrigation solution.

Preparation cont’d…… Good lighting and visualization. Adequate analgesia. General anesthesia or regional anesthesia for proper muscle relaxation or extensive tears. Pudendal block

Management: Vaginal Laceration May involve both sides of vaginal floor. Anchor suture 1 cm above the apex. Running stitch. Locking for hemostasis. Should include vaginal mucosa and rectovaginal fascia. Continue running suture upto hymenal ring.

Perineal Muscle Repair Indicated in second through 4th degree tear. Bulbocavernosus located immediately below the introitus. Transverse perineal muscles located above the external anal sphincter.

Perineal Skin Repair Controversial: may assoc with perineal pain. Indicated if skin not approximated. Running subcuticular suture superior to interrupted transcutaneous suture.

Postpartum Care Sitz bath Ibuprofen Stool softener in 3rd and 4th degree tear.

Prevention Minimize episiotomy and forceps delivery.