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Re: 4th degreeFrom: Joanne Bulley (jbulley@cheshire.net)Tue May 25 19:16:56 1999
In a message dated 5/24/99 8:51:13 PM, garrys@mindspring.com writes: << 2. When you get a 4th degree, what tricks do you use to repair it? >> Well - I won't get any for awhile - not doing Ob - but - I was taught to think of any epis repair as a posterior colporrhaphy / perineorrhaphy - depending on the site ... rectal mucosa inverted with continuous 0000 vicryl rectal sphincter repaired with three figure-of-eight sutures of 0 vicryl recto-vaginal "septum" or support repaired with interrupted 00 vicryl vaginal mucosa / epithelium "as usual" - 000 chromic or vicryl, separate sutures for the vaginal portion and the perineal portion. No antibiotics, just lots of warm soaks, sitz baths, etc.
-- Joanne Bulley, MD
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