{"id":1760,"date":"2010-12-14T07:32:33","date_gmt":"2010-12-14T07:32:33","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/suturing-a-mediolateral-episiotomy\/"},"modified":"2023-08-15T12:24:19","modified_gmt":"2023-08-15T11:24:19","slug":"suturing-a-mediolateral-episiotomy","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/obstetrics\/management-of-childbirth\/suturing-a-mediolateral-episiotomy\/","title":{"rendered":"Suturing A Mediolateral Episiotomy"},"content":{"rendered":"\n<p><strong>Suturing a mediolateral episiotomy wound<\/strong><\/p>\n\n\n\n<p><strong>Material <em>[Figure 39]<\/em><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Curved cutting suture needle.<\/li>\n\n\n\n<li>Curved blunt suture needle.<\/li>\n\n\n\n<li>Suturing thread: Polyglycolic acid-based (Dexon\u00ae, Vicryl\u00ae).<\/li>\n\n\n\n<li>Needle guide.<\/li>\n\n\n\n<li>Scissors.<\/li>\n\n\n\n<li>Anatomical tweezers.<\/li>\n\n\n\n<li>Surgical tweezers.<\/li>\n\n\n\n<li>Haemostatic forceps (Kocher clamp).<\/li>\n\n\n\n<li>Gauze squares.<\/li>\n\n\n\n<li>Gynaecological tampon.<\/li>\n<\/ul>\n\n\n\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"294\" class=\" size-full wp-image-1759\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-39.jpg\" alt=\"\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-39.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Obstetrics_ob-fig-39-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\"><strong>Figure 39<\/strong><\/span><\/span><\/p>\n\n\n\n<p>A <strong>curved cutting needle<\/strong> is needed for skin sutures. The other tissue structures are sutured with a <strong>curved blunt needle<\/strong>. For the <strong>vagina<\/strong>, <strong>subcutis<\/strong> and <strong>muscle<\/strong>, a thread diameter of 0 gauge is sufficient. For the skin, Vicryl-Rapide\u00ae 00 gauge is recommended.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Procedure<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ensure <strong>good lighting<\/strong>. A good view of the operation area is essential for an optimal suture result and affects the time needed for suturing.<\/li>\n\n\n\n<li><strong>Disinfect<\/strong> the skin along the edges of the wound with a chlorhexidine solution 1% or a povidone-iodine (Betadine\u00ae) solution 10%.<\/li>\n\n\n\n<li>Always start with a <strong>careful inspection<\/strong> of the lacerations.<\/li>\n\n\n\n<li>Place a suture several millimetres above the top of the vaginal wound to fasten the blood vessels that emerge axially in the wound.<\/li>\n\n\n\n<li>Approximate the wound edges of the vagina with knotted sutures. Place the sutures about 1 cm apart.<\/li>\n\n\n\n<li>Restore the hymenal ring on the transition from the vagina and vulva carefully with a suture just inside the remnant of the hymen to prevent dyspareunia.<\/li>\n\n\n\n<li>Suture the incised muscle bellies of the <strong>bulbocavernosus<\/strong> muscle with two knotted sutures. Good approximation prevents weakening of the pelvic floor. The suturing technique with which the bulbocavernosus muscle is repaired with knotted sutures, provides a better <strong>anatomical<\/strong> and <strong>functional<\/strong> recovery of the vaginal sphincter than the technique in which the entire episiotomy is sutured with a continuous thread.<\/li>\n\n\n\n<li>Close the subcutis with knotted sutures. Start distally and take the unequal wound edges into account.<\/li>\n\n\n\n<li>Suture the skin <strong>distally to proximally<\/strong> (towards the hymenal ring) with <strong>knotted sutures<\/strong> or <strong>intracutaneously<\/strong> with a continuous polydioxanone\/polyglycolic acid-based thread (Vicryl-Rapide\u00ae).<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Suturing a mediolateral episiotomy wound Material [Figure 39] Figure 39 A curved cutting needle is needed for skin sutures. The other tissue structures are sutured with a curved blunt needle. For the vagina, subcutis and muscle, a thread diameter of 0 gauge is sufficient. For the skin, Vicryl-Rapide\u00ae 00 gauge is recommended. Procedure<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[58],"tags":[138],"class_list":["post-1760","post","type-post","status-publish","format-standard","hentry","category-management-of-childbirth","tag-obstetrics"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Suturing A Mediolateral Episiotomy - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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