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Questions and Answers
Which muscle contributes additional muscle fibers to the perineum?
Which muscle contributes additional muscle fibers to the perineum?
What is the incidence of trauma requiring suturing due to perineal trauma?
What is the incidence of trauma requiring suturing due to perineal trauma?
What is the main reason for obstetric perineal lacerations classification into first to fourth degree?
What is the main reason for obstetric perineal lacerations classification into first to fourth degree?
Which ligament bounds the perineum at the upper border?
Which ligament bounds the perineum at the upper border?
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What type of muscle composes the internal anal sphincter?
What type of muscle composes the internal anal sphincter?
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What can perineal trauma lead to?
What can perineal trauma lead to?
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What type of suture results in decreased wound dehiscence and less postpartum perineal pain compared to catgut and chromic suture?
What type of suture results in decreased wound dehiscence and less postpartum perineal pain compared to catgut and chromic suture?
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What should be given intravenously before a procedure involving severe perineal lacerations with anal sphincter complex involvement, to reduce the risk of infection?
What should be given intravenously before a procedure involving severe perineal lacerations with anal sphincter complex involvement, to reduce the risk of infection?
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Where is the perineum located anatomically in relation to the pelvic floor and the external genitalia?
Where is the perineum located anatomically in relation to the pelvic floor and the external genitalia?
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What structures are found in the superficial perineal space?
What structures are found in the superficial perineal space?
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Why is knowledge of perineal anatomy crucial in surgical cases related to trauma and congenital abnormalities?
Why is knowledge of perineal anatomy crucial in surgical cases related to trauma and congenital abnormalities?
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What is the main reason for performing irrigation before surgical repair of severe perineal lacerations?
What is the main reason for performing irrigation before surgical repair of severe perineal lacerations?
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Study Notes
The perineum refers to the region of the human body located between the vagina and the rectum, extending from the inferior aspect of the pubic symphysis to the coccyx and bounded by the ischiopubic ramus, ischial tuberosities, and the upper border of the sacrotuberous ligaments. The perineum is formed predominantly by the bulbocavernosus and transverse perineal muscles, with the puborectalis muscle and the external anal sphincter contributing additional muscle fibers. The anal sphincter complex lies inferior to the perineal body, with the external anal sphincter composed of skeletal muscle and the internal anal sphincter composed of smooth muscle, continuous with the smooth muscle of the colon.
Perineal trauma can occur during vaginal birth, leading to obstetric anal sphincter injury (OASI), which is associated with significant short- and long-term morbidity. The incidence of some form of perineal trauma is reported to be 85%, and the incidence of trauma requiring suturing ranges from 44% to 79%. Perineal trauma is associated with intense pain that can require pain relief, dyspareunia, fecal incontinence, and can lead to major physical, psychological, and social problems, affecting the ability to care for the newborn and cope with daily tasks of motherhood.
Obstetric perineal lacerations are classified as first to fourth degree, depending on their depth. The repair of these lacerations requires good lighting, visualization, proper surgical instruments, and adequate analgesia. The use of 3-0 polyglactin 910 (Vicryl) suture results in decreased wound dehiscence and less postpartum perineal pain compared with surgical repair using catgut or chromic suture. With severe perineal lacerations involving the anal sphincter complex, irrigation is performed to improve visualization and reduce the incidence of wound infection, and a single dose of a second- or third-generation cephalosporin may be given intravenously before the procedure to reduce the risk of infection.
The perineum is a diamond-shaped space below the pelvic floor, extending between the inferior fascial layer of the pelvic diaphragm and the perineal skin, which is continuous with the skin of the external genitalia. The superficial perineal space contains the erectile tissues, skeletal muscles, and the terminal branches of the internal pudendal vessels and nerves. Knowledge of the anatomy of the perineum is necessary to provide the best surgical outcomes in cases related to trauma, cancer-related extirpation, and congenital abnormalities.
In summary, the perineum is a crucial region of the human body, and understanding its anatomy is essential in providing optimal surgical outcomes and reducing morbidity associated with perineal trauma.
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Description
Learn about the anatomy of the perineum, perineal trauma, obstetric perineal lacerations, repair techniques, and the importance of understanding perineal anatomy for surgical outcomes. Gain insights into the region between the vagina and rectum, muscle involvement, potential injuries during childbirth, and treatment options.
