Timing and Technique: Principles of Secondary Repair of Perineal Wound Dehiscence
Victoria M Li1, Elise Heisler2, Robyn A Lipschultz2
1Department of Obstetrics and Gynecology, NYU Langone Health, 550 1st Ave, New York, NY, 10016, USA. Victoria.Li@nyulangone.org.
Insights
Early resuturing within two weeks for perineal wound breakdown shows good outcomes. Optimal management involves antibiotics, specific sutures, and specialist consultation, particularly for obstetric anal sphincter injuries (OASIS).
Area of Science:
- Obstetrics and Gynecology
- Surgical Wound Management
Background:
- Perineal wound breakdown is a rare but significant complication after childbirth.
- Current management strategies for perineal wound dehiscence are debated.
- Obstetric anal sphincter injuries (OASIS) present unique challenges in wound management.
Purpose of the Study:
- To systematically review existing data on the management of perineal wound dehiscence.
- To emphasize optimal timing, surgical techniques, personnel, and outcomes.
- To address considerations specific to obstetric anal sphincter injuries (OASIS).
Main Methods:
- A systematic literature search was conducted using PubMed, SCOPUS, and EMBase.
- Thirteen relevant articles were included in the review.
- Data on management strategies, outcomes, and complications were compiled.
Main Results:
- The majority of studies (11/13) reported resuturing within 2 weeks.
- Intraoperative antibiotics (10/13) and polyglactin sutures (13/13) were commonly used.
- Complete healing rates ranged from 57.1% to 92.9%, with dyspareunia as the most frequent complication (5.6-27.8%).
- Repairs for OASIS breakdown often required specialist consultation and were linked to incontinence (13.6-37.0%).
Conclusions:
- Early resuturing within two weeks is supported by evidence for good short-term outcomes.
- Optimal management includes intraoperative cephalosporin, polyglactin sutures, and specialist consultation for suspected OASIS breakdown.
- Further research is needed on long-term outcomes and patient satisfaction with repair revision techniques.
Introduction And Hypothesis:
Perineal wound breakdown is a rare but important complication following childbirth-related perineal trauma. Though many providers manage wound breakdown via expectant management, the optimal strategy remains debated. In this review, we systematically compile a comprehensive overview of existing data on management of perineal wound dehiscence with emphasis on timing, surgical technique and personnel, outcomes, and considerations to obstetric anal sphincter injuries (OASIS).
Methods:
Our literature search utilized PubMed, SCOPUS, and EMBase databases.
Results:
Thirteen relevant articles were included in our review. The majority of studies reported resuturing within 2 weeks of diagnosis (11/13), utilizing intraoperative antibiotics (10/13) and polyglactin suture (13/13). Repairs were largely completed in the operating room by an Ob/Gyn; Urogynecology and Reconstructive Pelvic Surgery (URPS) subspecialists were specified in two studies. Complete healing occurred in 57.1-92.9% of patients, typically by 3 months postoperatively, but also reported up to 1 year after repair. Dyspareunia was the most common complication (5.6-27.8%). Minor complications included superficial separation (14.3%) and surgical site infection (9.5%). Four studies focused on OASIS, and repair in these settings often required an URPS consultation and was associated with fecal urgency, flatal and/or fecal incontinence (13.6-37.0%).
Conclusions:
Evidence supports early resuturing within 2 weeks of perineal wound breakdown, demonstrating good short-term outcomes. Optimal management includes intraoperative cephalosporin administration, polyglactin sutures, and URPS consultation, especially if breakdown of OASIS is suspected. Future studies should examine long-term outcomes, such as rates of persistent anal incontinence, and overall patient satisfaction regarding the timing and techniques of perineal laceration repair revision.
