Stephanie Tyrrell

Suturing
Second degree tear repair

Second Degree Tear Repair

● Posterior vaginal wall

○ Using 3-0 vicryl and a CT-1 or CT-2 needle depending on depth of
tear
○ Anchor stitch just above the apex of the tear
○ Mattress stitch or basting stitches down the length of the tear. If
there is a lot of bleeding from the tear a blanket locking stitch can be
used.
■ Deep vaginal stitches
● If the tear is especially deep, more than 2.5 cm, then
two layers of stitches may be needed.
● You can typically still begin with the first stitches as
normal and then if needed place a deep buried stitch at
the hardest to reach and deepest point first
● A single interrupted stitch can be used if needed as
well.
○ Finish the repair of the posterior vaignal wall around the hymnal ring,
tying off a knot at the end.

● Repairing the perineum

○ Subcutaneous continuous
■ If you have already been repairing the vaginal mucosa you
can continue down the perineum using a running mattress
stitch and finish of at the apex of the perineal tear leaving the
strand loose between the repair at the end of the vaginal
mucosa to the beginning of the perineum.
○ Begin the anchor stitch at the apex of the perineum
○ Using mattress stitches close the length of the tear till about .5 cm
before the introitus, then tie off.