A Second Chance at Success: Optimizing Revision Perineoplasty After Obstetric Perineal Laceration

INTRODUCTION: Perineal lacerations are common at the time of vaginal delivery. If the initial repair of an obstetrical laceration does not achieve a good anatomic or functional result, patients may experience dyspareunia, sexual dissatisfaction, discomfort, and poor cosmetic appearance. Revision perineoplasty to correct an anatomic defect can benefit these patients, and key surgical techniques can optimize this procedure. OBJECTIVE: This video will review surgical techniques and principles that improve cosmetic result and promote wound healing. The video will demonstrate the steps of a revision perineoplasty and discuss preoperative and postoperative considerations. METHODS: After obtaining informed consent from the patient undergoing a planned revision perineoplasty, a video was recorded demonstrating the key steps of the procedure. We use a lowercase “t” incision along the anterior perineum and distal vagina and across the introitus to dissect the mucosa and skin from the fibromuscular tissue. A concurrent rectal exam improves visualization and prevents rectal injury. Preoperative antibiotics, copious irrigation, and the use of interrupted delayed absorbable sutures placed in close proximity to one another promote wound healing and cosmesis. RESULTS: At completion of the procedure, normal perineal height was restored and the introitus had normal contour. CONCLUSIONS: A revision perineoplasty, when performed correctly, can restore normal anatomy after a poorly healed obstetric injury. There are several key surgical techniques that can prevent wound infection and breakdown, and improve cosmetic outcome.