Question

What is the correct sequence of repair of episiotomy?

• A. Mucosa $\rightarrow$ Muscle $\rightarrow$ Skin
• B. Skin $\rightarrow$ Muscle $\rightarrow$ Mucosa
• C. Muscle $\rightarrow$ Mucosa $\rightarrow$ Skin
• D. Mucosa $\rightarrow$ Skin $\rightarrow$ Muscle

Hint:

Episiotomy repair follows the order: inside to outside = mucosa, muscle, skin.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
The question asks for the standard anatomical order of closing a perineal incision (episiotomy) following a vaginal delivery.
Step 2: Detailed Explanation:

Surgical Principles: Repair is performed in a systematic way from the "inside-out" to ensure proper anatomical alignment and hemostasis.

Layer 1: Vaginal Mucosa: The repair starts at the apex of the vaginal incision (about 1 cm above the apex to ensure any retracted vessels are caught). A continuous suture is typically used to close the mucosa down to the level of the hymeneal ring.

Layer 2: Perineal Muscles: The torn muscles of the perineal body (primarily the bulbocavernosus and transverse perineal muscles) are approximated using interrupted or continuous sutures. This step is crucial for restoring the structural integrity of the pelvic floor.

Layer 3: Skin: Finally, the perineal skin and subcutaneous tissue are closed. This can be done with interrupted sutures or a continuous subcuticular (hidden) suture, which is often preferred as it reduces post-operative pain.

Materials: Delayed absorbable sutures (like Polyglactin 910 or Chromic catgut) are usually used so that no suture removal is necessary.

Step 3: Final Answer:
The correct anatomical sequence for episiotomy repair is Vaginal Mucosa, followed by the Muscle layer, and finally the Skin.