How to – Perineal body reconstruction

Indications

The perineal body is reconstructed when it is weakened by trauma or torn with parturition. A Caslick’s is often sufficient for reconstructing the region; however, if pneumovagina continues, perineal body reconstruction may be required.

Relevant anatomy

The perineal body is a muscular structure dorsal to the vagina and ventral to the rectum. It provides support to the vestibular seal, the second barrier to the uterus as well as to the vulvar lips.

Due to its location, it is easily traumatized during parturition.

At the time of injury, tissues are very friable and undergoing more necrosis. Surgery should be postponed until the area is well healed.

Preoperative management

Food restrictions: NA

NSAIDs/analgesics: Preoperative NSAIDs are recommended

Antibiotics: Preoperative antibiotics are recommended.

Tetanus prophylaxis is recommended. 

Local blocks: Local infiltration or epidural

Position/preparation: Repair at the time of injury is unrewarding as most will dehisce. Repair should wait until the area has developed fibrous tissue, at least 3-4 weeks. The procedure is done standing with the patient sedated as needed.  Surgeon should be gloved.

Surgery Supplies: 

• Scalpel and handle
• Metzenbaum scissors
• Thumb forceps
• Needle holders
• Suture scissors
• 2-0 to 3-0 absorbable suture, taper needle
• 2-0 suture, cutting needle (Caslick’s)

Surgical procedure

Stay sutures are held by an assistant or clamped to the perineum to provide exposure. The healed epithelial tissue is dissected off the surface, creating fresh edges in a roughly triangular pattern, extending the depth of the tear.

Once the edges are freshened, the two sides are apposed starting the in deeper tissues and using any pattern. Often cruciates are most useful

The most superficial layer is closed as for a Caslicks (continuous split thickness pattern) or with an interdermal pattern.

Postoperative care

• Keep the area clean and dry.
• Suture removal if needed in 10-14 days

Complications

The perineal body will not be as strong or as flexible as it was originally; this may lead to tears with parturition.

Videos

Resources

Vulva, vestibule, vagina and cervix,  Equine Surgery

Surgery of the Bovine Reproductive System and Urinary Tract, Farm Animal Surgery 2nd edition