Suturing Severe Perineal Lacerations.

Anal sphincter and rectal mucosal lacerations are serious complications that can occur during childbirth. The obstetrician must be trained to correct these lacerations when they occur. The objective of this simulation is the training of the suture of the rectal mucosa, internal sphincter and external sphincter of the anus.

The description of this simulator and an evaluation of its use is published in the Revista Brasileira de Ginecologia e Obstetricia:

Knobel R, Volpato L, Gervasi L, Viergutz R, Trapani A. A Simple, Reproducible and Low-cost Simulator for Teaching Surgical Techniques to Repair Obstetric Anal Sphincter Injuries. Rev Bras Ginecol e Obs / RBGO Gynecol Obstet [Internet]. 2018 Aug 24;40(08):465–70. Available from: http://www.thieme-connect.de/DOI/DOI?10.1055/s-0038-1668527

 

Required Material

• 1 chocolate bar or a tube of toothpaste
• Condom
• Fabric scrap approximately 7 x 7 cm
• 1 Piece of beef with symmetrical fibers cut like a “fajita” of 10 cm x 1 cm. (here “Patinho” was used)
• Steel tray or other surface to perform the procedure
• Suture threads
• Suture material (needle holder, forceps, Allis forceps)

Step by step

It is interesting to assemble the model together with the students. This allows for an anatomy – physiology review. At this point, slides can be used to show the actual anatomical structures.

• We place the slice of meat – it represents the external sphincter of the anus
• We place the piece of fabric over the meat – it represents the internal sphincter of the Anus.
• We place the condom with the chocolate inserted – The condom represents the rectal mucosa and the chocolate the intestinal contents (it is necessary to give “volume” to the model).
• Lacerate the condom and external sphincter – approximately 1 centimeter.

Suture

Start the suture through the intestinal mucosa (condom) – continuous stitches

Suturing the internal anal sphincter – continuous stitches – it is important to remember that this step is important in the real situation, because it increases the probability of faecal continence and flatus after the laceration.

Suturing the external anal sphincter.

Both techniques can be trained.

To reduce costs, we use catgut thread or other threads that have expired, but it is important to know the ideal thread for each sutured plane.

Have you made this model or similar?

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