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Total Perineal Reconstruction After Major Obstetrical Injuries with Extensive Tissue Loss: A Report of 2 Cases
Author(s) -
Lee S. H.,
Cheah D. S. H.,
Poopalarachagan S.,
Sivanesaratnam V.
Publication year - 1991
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1991.tb02827.x
Subject(s) - medicine , surgery , gangrene , debridement (dental) , perineum , general surgery , gas gangrene , fistula
EDITORIAL COMMENT: This paper was accepted for publication to remind readers that trauma to the genital tract at forceps delivery can result in infection and gangrene, with awesome tissue loss following debridement. Except for abortional Clostridial infection and one case of uterine gangrene with wound dehiscence after Caesarean section, the Editor has seen no such cases in 34 years practice in our discipline. Nor has he encountered a case of ‘symbiotic gangrene of a gynaecological abdominal wound requiring debridement’, although there are many reports of such cases. The details of the corrective surgery used in these 2 patients will particularly interest those surgeons trained to tackle cases of rectovaginal fistula. Summary: Major perineal injuries following obstetrical complications represent difficult problems of reconstruction. We describe 2 such patients with perineal injuries simulating infantile cloacas. Surgical repair using an abdominoperineal pullthrough procedure in 1 patient, and a Bricker loop type of repair in another resulted in successful restoration of function in both. The operative details and basis for the reconstruction are described.