Timing and Technique: Principles of Secondary Repair of Perineal Wound Dehiscence.

INTRODUCTION AND HYPOTHESIS: Perineal wound breakdown is a rare but important complication following childbirth-related perineal trauma. Though many providers manage wound breakdown via expectant management, the optimal strategy remains debated. In this review, we systematically compile a comprehensive overview of existing data on management of perineal wound dehiscence with emphasis on timing, surgical technique and personnel, outcomes, and considerations to obstetric anal sphincter injuries (OASIS).

METHODS

Our literature search utilized PubMed, SCOPUS, and EMBase databases.

RESULTS

Thirteen relevant articles were included in our review. The majority of studies reported resuturing within 2 weeks of diagnosis (11/13), utilizing intraoperative antibiotics (10/13) and polyglactin suture (13/13). Repairs were largely completed in the operating room by an Ob/Gyn; Urogynecology and Reconstructive Pelvic Surgery (URPS) subspecialists were specified in two studies. Complete healing occurred in 57.1-92.9% of patients, typically by 3 months postoperatively, but also reported up to 1 year after repair. Dyspareunia was the most common complication (5.6-27.8%). Minor complications included superficial separation (14.3%) and surgical site infection (9.5%). Four studies focused on OASIS, and repair in these settings often required an URPS consultation and was associated with fecal urgency, flatal and/or fecal incontinence (13.6-37.0%).

CONCLUSIONS

Evidence supports early resuturing within 2 weeks of perineal wound breakdown, demonstrating good short-term outcomes. Optimal management includes intraoperative cephalosporin administration, polyglactin sutures, and URPS consultation, especially if breakdown of OASIS is suspected. Future studies should examine long-term outcomes, such as rates of persistent anal incontinence, and overall patient satisfaction regarding the timing and techniques of perineal laceration repair revision.