lateral vulvar incision

Vulvar lateral incision is an obstetric surgery. Curing disease: Indication 1. In the first birth, the perineum is tight, the perineum is long, the tissue is hard or dysplastic, inflammation, edema, or the perineum is not fully expanded in case of emergency. It is estimated that the second degree of laceration will occur when the fetal head is delivered. By. 2, the head basin is not called for various reasons. 3, had a perineal incision and suture of the maternal, or repaired scars, affecting the perineal extension. 4, forceps midwifery, fetal head suction device midwifery or puerperal delivery of vaginal delivery. 5, premature delivery, intrauterine growth retardation or intrauterine distress need to reduce the pressure on the fetal head and early delivery. 6, the mother suffering from heart disease or high blood pressure and other diseases need to shorten the second stage of labor. Contraindications 1, can not be delivered through the vagina. 2. Those who refuse to undergo surgery intervention. 3. When the bleeding tendency is difficult to control. 4, the fetus is small, the previous delivery of the perineum is complete. Preoperative preparation 1. The perineum is prepared for skin. 2, procaine and selected antibiotic skin test. 3, catheterization. 4, vaginal examination. Surgical procedure 1. Median Episiotomy Disinfect the vulva when the fetal head is exposed, and spread the sterile towel and sheet. Local anesthesia or pudendal nerve block anesthesia. The fetal head is crowned, the uterus is contracted intermittently, and two fingers are inserted into the vagina to support the perineal body. A leaf is placed in the scissors. After the peak of the contraction, cut the yin body to the anal sphincter 1cm before, and continue to the left. Or right 45 ° and then cut 0.5 ~ 1cm, so as not to delay and anal sphincters. In the next contraction, one hand protects the perineum, and the other hand helps the child to bend and make it to the smallest circumference. If the cut is too early, the yin is not fully expanded, and the wound is prone to cracking. However, if it has not been crowned, it indicates that it has been naturally torn and should be cut in time. When the placenta is delivered, the examination is complete, the uterus contracts well, and there is not much bleeding, which can be sutured. Wash the wound before suturing, disinfect, spread the towel, and check for cracks. The mucosa was continuously sutured with a 2-0 gut, aligned with the hymen ring, and ligated at the scaphoid. Tighten the suture and check if the incision is tight and flat. One stitch of the corpus cavernosum muscle on both sides of the deep seam, intermittently suture the perineal body. The subcutaneous tissue is thicker and the gut is sutured intermittently, otherwise it can be sutured intermittently with the skin. After suturing, count the number of needles and disinfect the epidermis. 2, perineal left (right) medial incision (Mediolateral Episiotomy) Vulvar preparation and anesthesia are seen before. The normal delivery child makes a small incision, the timing is cut with the median; the forceps or suction device for midwifery or gluteal birth is performed before the delivery, making a larger incision. The small incision is opened from the posterior midline of the labia and left or right obliquely 45°. The height of the perineal body is slightly upward at 60°, and it can be restored to 45° after delivery. The skin incision is about 3cm long. If the mucosal incision is not long enough, it should be extended to 4~5cm long and long incision with the skin incision. It is often necessary to cut it twice. Pay attention to cutting the levator ani muscle so that there is no resistance in the middle of the incision, so as to prevent the incision from spreading along the inner edge of the levator ani muscle to the rectum when the baby is delivered. The saline gauze presses the wound to stop bleeding, and the active bleeding point should be sutured to stop bleeding. After the baby is delivered, the amniotic fluid flows through the wound, and the procoagulant substance can stop the bleeding immediately. The forceps or midwife often causes the vaginal wound to extend up to the sputum, deep back and the front of the rectum, the side wall, sometimes in addition to the side cut wound, the perineal body also split, even involving the anal sphincter and rectum. This kind of wound is not neat and has a lot of bleeding. 3. In addition to the intermittent suture of the skin, the continuous subcuticular suture or the "shute technique" can be used. Under the epidermis, a 3-0 intestine was worn with a triangular needle, and 1 needle was sutured from the distal end of the incision, and the needle was cut, and a tail was cut. The suture was sutured to the vaginal opening, and the knot was cut. This method is suitable for small incisions without complicated lacerations. There is no need to remove the thread after surgery. However, if the infection is suppuration, it is better to expand the drainage than to interrupt the suture. The "8" suture system sutures the skin and the subcutaneous tissue continuously, and wears the No. 7 silk thread with a triangular needle. Pay attention to the deep subcutaneous tissue, and the ligation is moderate. The advantage of this method is the subcutaneous wireless knot, the tissue is soft after the thread is removed, and the healing is good. However, those who are unskilled are prone to stay in the dead. complication 1, blood loss Causes of perineal incision bleeding are: 1 side cut or middle side cut easily and perineal arteriovenous, bleeding more than the median incision; 2 perineal incision earlier, fetal head failure to oppress the perineal tissue more bleeding, large incision, Bleeding is not possible when the fetus is not delivered immediately; 3 complicated laceration caused by surgery; 4 pregnancy-induced hypertension syndrome; 5 coagulation mechanism disorders, such as disseminated intravascular coagulation, thrombocytopenic purpura. The delivery operator sometimes mistakes the wound bleeding for uterine contraction bleeding, which delays the treatment. Wound hemorrhage usually begins before the placenta is delivered, and it is a continuous active bleeding. It has nothing to do with uterine contractions, and it is not effective for uterine contractions. The uterine bleeding often flows out during contractions or by pressing the bottom of the sputum, often containing large blood clots. However, there are also wounds that bleed in the deep part of the vagina and are pushed out when the uterus is pressed. The recipient should pay attention to the bleeding of the wound after the perineal incision, and the active bleeding should be immediately sewed. The gauze should not be used to stop the bleeding; the placenta should be sutured quickly after delivery; the coagulation mechanism is treated according to the cause; The shock recipient supplemented the blood volume to correct the shock. 2, perineal hematoma The causes of hematoma were as follows: 1 the vascular end of the leaking retraction; 2 the bleeding point was not sutured in time, or the basic operation was not formal, and the hemostasis was imperfect; 3 the needle pierced the blood vessels in the tissue, but it was not detected at that time; The deep blood vessels were contused and the blood did not flow out, which was not found during surgery. Therefore, in the prevention and treatment of hematoma, in addition to perfect operation, it is necessary to observe closely after surgery and find out early. The symptoms of postpartum perineal hematoma are mainly due to the pain of wounds gradually increasing, the anus swells, the local swelling and tenderness are gradually aggravated, and the anal can refer to cystic masses. The perineal hematoma is small. If you do not continue to increase, you should give it to the cold compress. Give the hemostatic drug. If you continue to enlarge, you should remove the wound suture to stop bleeding and re-sewn. 3, wound infection The main causes of infection are: 1 aseptic operation is not required, and the incision is contaminated; 2 the suture technique is poor, leaving a dead space, or the suture is too dense, the ligation is too tight, affecting blood supply and causing tissue necrosis; 3 on the basis of hematoma Infection; prenatal vaginal infections, such as trichomonas vaginitis. The infection status often occurs after 3 to 5 days after the operation. The maternal wound continues to be painful, or it is aggravated after being relieved. It is often a painful, local redness. Press the incision with a finger to soften the area. If you open it, you can see the inflammatory exudate or The pus overflows, and the size and depth of the cavity are different. Although some women complained of wound pain, there was no obvious abnormality in the examination. The treatment with antibiotics and hot water bathing still did not relieve. It was often found that the incision was locally raised at different times after discharge from the hospital, and one or several thread heads were seen when the epidermis was opened. It can be cured after being cleared. Antibiotics and local hot compresses, bathing or physiotherapy should be given in the early stage of infection. Once a cavity or abscess is found, drainage should be completely expanded. If the vaginal cavity is vaginal, the sinus should be fully expanded. After partial cleaning, the second suture should be performed after the sprout is grown. The Secondary Repair of Episiotomy can be performed under ramie, pudendal nerve block anesthesia or local anesthesia. First trim the edges of the wound and gently scrape the granulation surface to create a rough surface. The mucosa was sutured intermittently with a 1-0 gut, and the skin, subcutaneous and muscle were interrupted with a 7-gauge or nylon thread, and a thin tube was worn to protect the skin. 5 to 7d stitching.

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