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vaginal granulationFrom: David Zimmerman (fastedy@aloha.net)Mon May 27 04:06:38 1996
I have found the recent discussions surrounding the repair and suture of choice for the double laceration to be of interest since it ties into a case I have and would appreciate the list's aid. My 36 y.o. patient is now 10 weeks postpartum with painful granulation tissue overlying the repair of her vaginal lacerations which occurred at the time of her vacuum delivery. She experienced a 2nd degree perineal as well as as a right side wall laceration (the vaginal wall laceration extended to the hymeneal ring). The side wall laceration was jagged but the perineal laceration was midline and clean. The repair was done using 4-0 vicryl. The patient experienced a great deal of pain immediately postpartum and was evaluated several times after discharge for various complaints by different examiners. Her pain was attributed to hemorrhoid, which she *clearly* had. At one point, she stated the repair was "infected" but this was not confirmed by exam. None of the examiners noted anything unusual in the repair itself. By six weeks postpartum there was obvious exuberant granulation tissue which was tender to any manipulation. One area was treated with silver nitrate, but no subjective or objective improvement occurred. One week later, the patient the patient still had significant pain. She was tested again for diabetes (although the antepartum screen was negative). An HIV was also negative. The possibility of a surgical revision was discussed since the pain was nearly incapacitating. Since there was subjective improvement during the following week, further intervention was delayed. By ten weeks postpartum, the pain has not diminished and the tenderness on exam is impressive. I see no option but to proceed with debridement of the area. Any suggestions as to etiology? Could this be consistent with a tissue reaction to the vicryl (I am planning to use chromic for the next repair)? Any pearls re:surgical technique for the revision (other than an adequate margin around the affected tissue, say 0.5 cm) Mahalo. Terri Rosenbaum, M.D. Kauai Medical Clinic Lihue, Kauai, Hawaii "...it's all just a matter of ones and zeroes." - B. Coffey.
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