Re: Suturing second degree lacerations
From: Efrain Ramirez (eramirezt@coqui.net)
Wed Dec 21 20:12:25 2005
It has been my experience that not matter how great/bad I can "repair"
those lacerations - they will turn out great a few weeks later - that
area is greatly vascularized - with amazing healing powers .. thanks
God!!
Ef
At Wed, 21 Dec 2005, Garry E. Siegel, M.D. wrote:
>
>Fran:
>
>For longitudinal lacerations, those that run horizontally (i.e. from
>the urethral towards the rectum on the inner aspect of the labium
>minorum), try interrupted sutures of 4-0 chromic. Simply put the
>laceration together with sutures placed around 0.5 cm. apart, give or
>take. You may judge the distance between to be a bit closer--do it by
>experience. This will result in the most anatomic repair, and the
>sutures will dissolve and fall out quickly.
>
>For full-labial splits that "cross the grain," I used to try to bury
>sutures and actually had a couple fall apart. Now, I simply interrupt
>all the way around, and it looks better anatomically and heals nicely.
>
>Garry
>
>At Wed, 21 Dec 2005, fran wilson wrote:
>>
>>I can never get these to stay together. I stitch what I think is carefully, up one side and down the other with 4-0 Vicryl, and next time I see them it is all healed up with a little "notch" in the labia. So what am I doing wrong? The notch is usually very small 1/4 to 1/2 cm, but noticible by the patient. Bigger splits seem to heal a little better.
>>Fran Wilson CNM
>>
>>From: <igold@cox.net>Reply-To: ob-gyn-l@obgyn.netTo: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>Subject: Re: Re: Suturing second degree lacerationsDate: Wed, 21 Dec 2005 11:34:09 -0600I have always insisted that these be repaired. Moms are more cooperative if I tell them there is no choice, and it may interfere with sexual function if the "tag" is dragged in with intercourse. That said, I have seen a couple unrepaired over the years. They don't reapproximate spontaneously.Ingrid>> From: annam@uic.edu (Anna Meenan, MD)> Date: 2005/12/21 Wed AM 08:27:55 EST> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>> Subject: Re: Suturing second degree lacerations>> Well those you sorta have to repair, but the ones that tear>
>>longitudinally down the side of the labia I leave alone unless active> bleeding, and I give it a good while to see if it will stop (i.e. I> don't suture while waiting for placenta).>> Anna Meenan, MD>> At Wed, 21 Dec 2005, Elrod Darryl G MAJ 48 MDOS/SGOBO wrote:> >> >What do you do then for deliveries that split the labia? I had two in a> >row last week and I even had tried to sit on my hands during the> >delivery! Both of them tore right through the labia. I feared that if> >I didn't at least reapproximate them, she would be left with two> >separate parts of her labia and not be pleased.> >> >Glen> >> >-----Original Message-----> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Anna> >Meenan, MD>
>>>Sent: Wednesday, December 21, 2005 3:41 AM> >To: Multiple recipients of list OB-GYN-L> >Subject: Re: Suturing second degree lacerations> >> >I used to suture everything. Then my most difficult patient (bipolar> >with extreme needle-phobia) refused to have her 2nd degree repaired.> >The> >nurses made her sign a refusal and I went over all the possible risks,> >but it healed beautifully. Couldn't even see the scar line 6 weeks> >later (as opposed to some women where I can see the line from their epis> >years later). Have never again left a second-degree unrepaired, but> >have left many 1st degrees unrepaired since then, and have always> >silently thanked my difficult patient for showing me the healing powers> >of the female perineal body.>
>>>> >Also, having personally experienced both sutures in the perineum and> >sutures in the labia minora on various occasions, I would avoid putting> >sutures anywhere near the labia at all costs.> >> >Anna Meenan, MD> >> >At Tue, 20 Dec 2005, GA12L@aol.com wrote:> >>> >>Thanks for that Ingrid. It backs up the research that suggests that> >>unsutured tears heal just as well with less pain. And the fact that> >sutures pull> >>once healing starts. I remember it so well, the pain was awful and I> >had to> >>have them removed before they dissolved because I couldn't sit down.> >Bathing> >>helped but only for an hour or 2.> >>> >>I have left 2nd degree tears that are not bleeding after
>>discusing it> >with> >>the woman but if she wants to be sutured then I'll suture.> >>> >>Gail>>
>
>--
>Garry E. Siegel, M.D.
>Private Practice
>Roswell, GA
>
--
Ability is what you're capable of doing.
Motivation determines what you do.
Attitude determines how well you do it.
- Lou Holtz
