Early secondary repair of third- and fourth-degree perineal lacerations after outpatient wound preparation

Research has shown the feasibility of early secondary repair of third- and fourth-degree perineal laceration dehiscence after a short period of inpatient wound preparation; therefore, we evaluated the feasibility of early closure after outpatient wound preparation. In this case series, 23 patients underwent early repair of third- or fourth-degree perineal laceration after outpatient wound preparation. Twenty-one patients (91%) had a fourth-degree dehiscence, whereas two (9%) had a third-degree dehiscence. We repaired the defects after 4-10 days (mean 7) of outpatient debridement and wound preparation. All repairs were successful (95% confidence interval 85-100%), and no subsequent breakdowns occurred. One patient developed a small rectal-perineal fistula which, after irrigation, closed spontaneously within 3 months. Early repair of third- or fourth-degree dehiscence after outpatient wound debridement and preparation is both practical and effective. Forcing patients to wait the traditional 3-4 months before repairing such defects may be both cruel and unnecessary.