Which Suture Materials Should Be Used to Accomplish Repair of Obstetric Anal Sphincter Injuries?
A – When repair of the EAS muscle is being performed, either monofilament sutures such as polydiaxanone (PDS) or modern braided sutures such as polyglactin (Vicryl®) can be used with equivalent outcome. C – When repair of the IAS muscle is being performed, fine suture size such as 3-0 PDS and 2-0 Vicryl may cause less irritation and discomfort. Postoperative Management How Should Women With Obstetric Anal Sphincter Injury Be Managed Postoperatively? C – The use of postoperative laxatives is recommended to reduce the incidence of postoperative wound dehiscence. A systematic review addressing the antibiotic prophylaxis for fourth-degree perineal tear comparing prophylactic antibiotics with placebo or no antibiotics did not find any randomised controlled trials. However intraoperative and postoperative broad-spectrum antibiotics are recommended because the development of infection will pose a high risk of anal incontinence and fistula formation in the event of breakdown of the anal sphinc
