The choice of suture materials and techniques for repair of perineal trauma: an overview of the evidence from controlled trials.

A systematic review of the 14 relevant controlled trials was conducted because there is no agreement about the choice of material and technique for repair of perineal trauma sustained during childbirth. Derivatives of polyglycolic acid (marketed as Dexon and Vicryl) appear to be the absorbable material of choice for both deep and skin closure. Compared with catgut their use is associated with about a 40% reduction in short-term pain and need for analgesia. The main drawback is that some material often needs removal during the puerperium. Glycerol-impregnated catgut is ruled out because of its link with long-term dyspareunia. Compared with the non-absorbable materials (silk and nylon) polyglycolic acid skin sutures were associated with less short-term perineal pain, and had no clear disadvantages. Continuous, subcuticular stitching appears preferable to interrupted, transcutaneous suturing, particularly in terms of perineal pain in the early puerperium.