perineal laceration repair

Perineal laceration or complete perineal laceration, including vaginal laceration, perineal laceration and anal sphincter laceration, severe rupture can extend to the rectal wall, causing stool and gas incontinence. Need surgery for treatment. Treatment of diseases: perineal laceration Indication 1. Perineal I, II, and III degree lacerations are required to be sutured, and are also performed within 8 hours of production. If there is no infection, it should be completed within 24 hours. 2. In the case of an old III degree perineal laceration, surgery should be performed without fertility requirements. 3. The vaginal opening is slack and the stool cannot be controlled. Contraindications 1. Acute inflammation of the lower genital tract. 2. Patients with severe internal surgery complications cannot tolerate surgery. Preoperative preparation 1. Sterile saline thoroughly washes the wound. The vascular clamp clamps the saline gauze into the anal rupture to the upper end of the rupt. 2-3cm, wipes the mucus and feces in the rectum and anus, and disinfects the mucous membrane and iodine alcohol disinfection. skin. 2, change the sterile towel, single, the operator changed the gloves, re-lay the sterile table, change the disinfection equipment. 3, vaginal nerve block anesthesia, or local infiltration anesthesia. 4, the vaginal internal stopper with the tail of the saline yarn pad. Surgical procedure 1. At the time of surgery, the fresh wound has no scar tissue and is easy to heal, but sometimes the muscles that are torn are disordered, and the level must be recognized. The free rectal wall does not have to be excessive. The sphincter is strong and can be sutured with silk thread or II chrome gut. The wound is easily infected because there is no intestinal preparation before surgery. When repairing the anterior wall of the rectum, the first layer must not pass through the rectal mucosa, such as the line through the mucosa, knotted in the rectal cavity, the most important is the suture of the first needle, if you can not see clearly, you can put a finger in the rectum Give instructions inside. 2, suture sphincter can be used II chrome gut line or medium-sized silk thread, first lift the sphincter, try to have or not. After suturing the levator ani muscle, the sphincter is sutured and sutured from the inside to the outside for easy operation. Before suturing the vaginal wall, flush the wound with saline and inject antibiotics around the wound to reduce the chance of infection. 3, looking for the anal sphincter broken end, the retracted anal sphincter broken end can be found in the depression of the anal skin folds. First, the curved vascular clamp is inserted into the subcutaneous tissue to separate the gap; then the tissue forceps are inserted into the gap to obtain a large end of the sphincter sphincter, avoiding several pulls, resulting in little residual muscle fiber damage. The two ends of the broken end are found to be pulled back to the midline, and one finger is extended into the anus to understand whether the anal finger is tightened or not. The sphincter was sutured with a 2-3 needle medium thread. complication The vaginal wall is slack.

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