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2.2.3 Setup: Instruments and Materials

Setup for Repairing Lower Genital Tract Lacerations

Clinical Pearl: Consider taking the patient to the OR for the repair! Good lighting, good assistance and good analgesia are essential.  Some complicated lacerations (i.e. fourth degree tears) don’t require immediate repair – they can be left packed and unrepaired for 8-12h.  Await help, if needed.

A pudendal block can be useful in providing analgesia for repairs.

Materials for Repairing Lacerations

For all repairsAdditional, for Higher Order or Complex tears
Sterile drapes and glovesFoley catheter
Irrigation solution
(warm sterile saline or water)
Allis clamps (for anal sphincter repairs)
Needle driverRing forceps (for cervical repairs)
Suture scissors
Tissue forceps
(prefer Russians or toothed)
Retractor(s) – Heaney, Sims, Breisky, weighted speculum.
*if forceps were used in delivery, one forcep may be used to retract
10cc syringe with 22-gauge needle
1% lidocaine (without epinephrine)
Sutures (see below)
Sponges

Suture Materials for Repairs

For closure of
vaginal mucosa and submucosa
absorbable 2-0 or 3-0 on CT-1 needle
— Vicryl: decreased postsurgical pain and lower rates of wound dehiscence compared to Chromic, but occasionally require removal of residual suture causing pain/dyspareunia
— Vicryl rapide: decreased likelihood of suture remnant remov
— Chromic
For skinabsorbable 3-0 or 4-0 on CT-1 or SH needle
— Vicryl rapide
For closure of
anal sphincter muscles
absorbable 0 or 2-0 on CT-1 needle
— Vicryl
— PDS (monofilament may be preferable as it is less likely to harbour organisms)
For closure of
anal mucosa
absorbable 3-0 on CT-1 needle
— Vicryl
— PDS
For cervical repairsabsorbable 2-0 on CT-1 needle
— Vicryl
Updated on June 28, 2021

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