title: Early secondary repair of third- and fourth-degree perineal lacerations after outpatient wound preparation.
abstract: Research has shown the feasibility of early secondary repair of third- and fourth-degree perineal laceration dehiscence after a short period of inpatient wound preparation; therefore, we evaluated the feasibility of early closure after outpatient wound preparation. In this case series, 23 patients underwent early repair of third- or fourth-degree perineal laceration after outpatient wound preparation. Twenty-one patients (91%) had a fourth-degree dehiscence, whereas two (9%) had a third-degree dehiscence. We repaired the defects after 4-10 days (mean 7) of outpatient debridement and wound preparation. All repairs were successful (95% confidence interval 85-100%), and no subsequent breakdowns occurred. One patient developed a small rectal-perineal fistula which, after irrigation, closed spontaneously within 3 months. Early repair of third- or fourth-degree dehiscence after outpatient wound debridement and preparation is both practical and effective. Forcing patients to wait the traditional 3-4 months before repairing such defects may be both cruel and unnecessary.
authors.affiliation: Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Arona
authors.forename: L
authors.initials: L
authors.lastname: al-Marayati
authors.forename: D A
authors.initials: DA
authors.lastname: Grimes
authors.forename: C A
authors.initials: CA
authors.lastname: Ballard
mesh_terms: D000553:Ambulatory Care; D003646:Debridement / Q000379:methods; D004841:Episiotomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D010502:Perineum / Q000293:injuries*; D011247:Pregnancy; D011300:Preoperative Care; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*; D013997:Time Factors