Vaginal Suture Repair Post Normal Delivery

Optimal Suture Material Selection

The American College of Obstetricians and Gynecologists recommends using monofilament absorbable synthetic sutures, such as poliglecaprone, for vaginal and perineal repair after normal delivery, as they minimize infection risk, reduce short-term pain, and decrease analgesic requirements 1
Monofilament sutures are preferred because they cause less bacterial seeding and have lower infection risk compared to multifilament options 1
Rapidly-absorbing synthetic sutures like polyglactin 910 eliminate the need for suture removal and may be justified by the lower need for postpartum suture removal 1

The American College of Obstetricians and Gynecologists recommends using a continuous non-locking technique for all layers of repair, as it reduces pain, decreases analgesic use, and lowers the need for suture removal 1
Continuous non-locking subcutaneous suturing avoids damage to nerve endings on the skin surface, reducing pain 1
Avoid locking sutures as they cause excessive tension leading to tissue edema and necrosis 1

Anchor suture above the apex of the vaginal epithelium laceration 1
Close vaginal epithelium and muscularis using continuous non-locking suture down to the hymenal ring 1
Reapproximate bulbocavernosus muscles with a crown stitch at the perineal body 1
Close perineal body musculature with continuous technique 1
Repair rectovaginal fascia if involved 1
Close perineal skin with continuous non-locking subcuticular stitch from inferior margin to hymen and tie 1

Ensure adequate anesthesia, optimize visualization and exposure, count all surgical instruments, sponges, and sutures pre- and postoperatively, and administer prophylactic antibiotics 1
Never use overly tight sutures that can strangulate tissue and impair healing 1
Avoid locking continuous sutures which increase tension 1
Do not use transcutaneous interrupted sutures on perineal skin as they damage superficial nerve endings 1
Avoid catgut or glycerol-impregnated catgut due to inferior outcomes 1

The American College of Obstetricians and Gynecologists supports the use of Vicryl for subcutaneous closure in multiple surgical contexts, including cesarean delivery and vaginal repair 2
Triclosan-coated Vicryl (Vicryl Plus) demonstrates reduced surgical site infection rates compared to standard Vicryl, with an odds ratio of 0.62 and a 95% confidence interval of 0.44-0.88 3

The World Health Organization recommends considering the use of antimicrobial-coated sutures, such as Vicryl Plus, for optimal infection prevention when available 3, 4