Episiorrhaphy is the repair of an Episiotomy. Whenever an incision is made, there is a need to stitch it back and the process of stitching it is called Episiorrhaphy; whereas the process of making the incision is called Episiotomy.
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Stitches used during Episiorrhaphy
Usually, there are 3 layers of tissues to be sutured.
- First layer: Continuous catgut suture for the vaginal tissue
- Second layer: Suture muscles in 2 layers with interrupted catgut sutures
- Third layer: Skin with interrupted sutures
Episiorrhaphy repair is very important and should not be left for junior doctors. It is usually repaired in 3 layers.
How to repair Episiotomy
- Counsel and obtain informed consent from the patient
- Use sterilized instruments and follow the aseptic procedure
- Infiltrate the area to be repaired with 10mls of 1% xylocaine
- Insert a perineal pad into the birth canal to prevent bleeding and lochia from obscuring the operating field
- Locate the apex of the episiotomy and go 1cm above to avoid damaging some blood vessels which might have retracted
- Suture the vaginal mucosa by continuous interlocking stitches using vicryl 2/0
- Stitch the muscular layer using simple interrupted stitches with vicryl 2/0 sutures
- The skin is closed by stitching the subcutaneous tissue using vicryl 2/0 sutures
- A vaginal examination is done when the perineal pad is removed to ensure the vaginal canal is not narrowed
- A rectal examination is also done to ensure no part of the rectal mucosa has been stitched
- Place the patient on prophylactic antibiotics and also give analgesics
- Clean the patient and let the patient lie in a supine position (lying on the back)
How to take care of an episiotomy wound
- Practice simple perineal care by making use of cotton wool with antiseptic lotion
- Keep the episiotomy site dry
- Do not use sitz bath (avoid it)
- Do not strain while in the toilet as it exerts pressure on the perineum
- Avoid food that may cause constipation and makes you strain and drink enough juice or water
- Stay in bed with your legs as close as possible to avoid stretching sutures
- Take multivitamins supplements to aid in healing
How long does it take for an Episiotomy wound to heal?
The healing time after episiorrhaphy is about 3 weeks to 6 weeks. This depends on the patient and the health status and also on the type of suturing technique and type of sutures used. When the wound is well taken care of and the woman eats well and avoids any stretch to the wound, the recovery time may be shortened.
When rapidly absorbed polyglactin 910 (Vicryl Rapids, Ethicon) is used, it takes 42 days for the sutures to be absorbed while the use of standard polyglactin 910 sutures takes 90 days.
The use of continuous repair is associated with less perineal pain after Episiorrhaphy.
- There may be trauma to the baby
- Pain following Episiorrhaphy
- Hematoma formation (formation of swelling which is an accumulation of blood)
- Infection of the Episiorrhaphy site leading to pain at the site, discharge, and smell)
- Suture breakdown
- Painful sexual intercourse (dyspareunia)