Setup for Repairing Lower Genital Tract Lacerations
Clinical Pearl: Consider taking the patient to the OR for the repair! Good lighting, good assistance and good analgesia are essential. Some complicated lacerations (i.e. fourth degree tears) don’t require immediate repair – they can be left packed and unrepaired for 8-12h. Await help, if needed.
A pudendal block can be useful in providing analgesia for repairs.
Materials for Repairing Lacerations
| For all repairs | Additional, for Higher Order or Complex tears |
| Sterile drapes and gloves | Foley catheter |
| Irrigation solution (warm sterile saline or water) | Allis clamps (for anal sphincter repairs) |
| Needle driver | Ring forceps (for cervical repairs) |
| Suture scissors | |
| Tissue forceps (prefer Russians or toothed) | |
| Retractor(s) – Heaney, Sims, Breisky, weighted speculum. *if forceps were used in delivery, one forcep may be used to retract | |
| 10cc syringe with 22-gauge needle | |
| 1% lidocaine (without epinephrine) | |
| Sutures (see below) | |
| Sponges |
Suture Materials for Repairs
| For closure of vaginal mucosa and submucosa | absorbable 2-0 or 3-0 on CT-1 needle — Vicryl: decreased postsurgical pain and lower rates of wound dehiscence compared to Chromic, but occasionally require removal of residual suture causing pain/dyspareunia — Vicryl rapide: decreased likelihood of suture remnant remov — Chromic |
| For skin | absorbable 3-0 or 4-0 on CT-1 or SH needle — Vicryl rapide |
| For closure of anal sphincter muscles | absorbable 0 or 2-0 on CT-1 needle — Vicryl — PDS (monofilament may be preferable as it is less likely to harbour organisms) |
| For closure of anal mucosa | absorbable 3-0 on CT-1 needle — Vicryl — PDS |
| For cervical repairs | absorbable 2-0 on CT-1 needle — Vicryl |