Perineal Laceration Repair
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Sphincter approach

Anal sphincter

Identify

Identify the degree of the rupture (classification by Sultan)
1st degree ruptures include only the tearing of the skin and subcutaneous tissue of the perineum and vaginal epithelium. 2nd degree rupture is characterized by tearing of the deep and superficial transverse perineal muscles, the bulbospongiosus muscles and the peroneal body.
3rd degree ruptures are divided in three levels, A (<50% of external anal sphincter) B (>50% external sphincter) and C (external and internal sphincter involved).
Most severe are the 4th degree lacerations where also the rectal mucosa is ruptured.

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