Perineal Repair

Summary

This instructional video demonstrates a second-degree perineal repair, focusing on the technique of suturing vaginal and perineal tissue. The repair is explained using two triangular sections: the vaginal mucosa and the perineal skin. The speaker walks through each step, from using specialized curved and straight needle drivers to lock stitches, burying the stitch, performing the crown stitch, and finishing with continuous subcuticular suturing. The process is designed to minimize tissue trauma, promote healing, and ensure proper alignment of the perineal area. The video offers expert insights for both beginners and seasoned practitioners.

Takeaways

• 😀 The procedure described is a second-degree perineal repair, specifically an episiotomy repair.
• 😀 The repair involves two main tissue layers: vaginal mucosa and the outer perineal skin.
• 😀 Two types of sutures are used: a round U-needle for deep stitches and a cutting needle for superficial stitches.
• 😀 The repair process begins with identifying and working on the apex (corner) of the tissue triangles to achieve hemostasis.
• 😀 Locking stitches are used for the mucosa to secure the tissue together and prevent bleeding.
• 😀 When working near the perineal ring, sutures are placed inside and outside the ring to avoid tension and reduce complications.
• 😀 The procedure includes a 'crown stitch' (Bubble cavernosa stitch) for deeper muscle attachment and ensuring stability.
• 😀 Sliding slip knots are used to minimize suture material at the site, providing a cleaner result with less foreign material.
• 😀 Subcutaneous stitches are employed to close the perineal skin, aiming for a smooth and functional closure.
• 😀 The use of a continuous subcuticular stitch technique ensures the tissue is brought together seamlessly from the bottom to the top of the tear.
• 😀 After stitching, the knot is tied securely, and the perineum is effectively closed, with the knot hidden underneath the skin for a neat appearance.

Q & A

What is the primary goal of the second-degree perineal repair described in the script?

The primary goal of the second-degree perineal repair is to repair a tear or episiotomy in the perineal region, focusing on bringing together the vaginal mucosa and perineal skin to promote healing.

How are the vaginal mucosa and perineal skin described in the procedure?

The vaginal mucosa and perineal skin are described as forming two triangles in the repair process. The vaginal mucosa represents one triangle, while the perineal skin forms the other, and the goal is to bring these two triangles together through stitching.

What type of suture material is used in this repair, and why are two different types of needles mentioned?

Vicryl suture is used, which has two needles— a round U needle for deeper stitches and a cutting needle for superficial stitches. The different needles ensure that the stitches are appropriate for their respective layers, with the round U needle suited for deeper, more secure stitches and the cutting needle used for more superficial closures.

What is the purpose of locking stitches in the vaginal mucosa repair?

The purpose of locking stitches in the vaginal mucosa is to secure the suture material in place, helping control bleeding and ensuring the tissues are held together properly for optimal healing.

How does the crown stitch (or Bublé cavernosa stitch) contribute to the repair?

The crown stitch is used to repair the deeper tissue, specifically the muscle layer. This stitch helps to ensure that the muscle layer is properly aligned and secured, contributing to the overall strength and stability of the repair.

Why is it important not to put the suture material through the actual hole ring in the repair?

It is important not to put the suture material through the actual hole ring because it is believed to reduce the risk of complications such as dehiscence or tension on the healing tissue, which can impair proper healing.

What are the benefits of using a sliding slip knot in this repair technique?

The sliding slip knot helps to minimize the amount of suture material used, which reduces bulk in the perineum and decreases the risk of tension and potential complications like hematoma or poor healing.

What is the technique for performing the subcuticular stitch on the perineal skin?

For the subcuticular stitch on the perineal skin, the needle is inserted about a millimeter below the skin, and the stitch is placed underneath the skin in a continuous manner. The goal is to bring the skin together with minimal visible scarring.

What does the term 'burry the stitch' mean in the context of this repair?

'Burying the stitch' refers to the technique where the suture is passed through the vagina and out through the midline underneath the tissue. This method hides the knot and suture material beneath the tissue, minimizing visible scars and irritation.

Why is it necessary to reverse the suture material when performing the subcuticular stitch?

Reversing the suture material helps to bring the tissue together from the bottom up, ensuring the wound edges align properly and the tissue heals without tension. It also sets up for the next part of the stitch, contributing to a clean, effective closure.