Episiotomy repair: chromic versus polyglycolic acid suture.

The use of an episiotomy for vaginal delivery is a controversial topic in modern obstetrics. If one is done, however, correct technique and appropriate suture material are important. On the LSU Obstetrics Service, the usual midline episiotomy has traditionally been closed with 2-0 chromic suture. Theoretically, the use of a less reactive material, eg, polyglycolic acid (Dexon), may be beneficial in terms of acute postpartum discomfort and healing. As a comparison of healing and patient comfort parameters between 2-0 chromic and 2-0 polyglycolic acid suture used for episiotomy repair after delivery, two consecutive months' worth of parturients at Medical Center of Louisiana/Charity Hospital had episiotomy repair, with either chromic or polyglycolic acid suture, by junior house officers routinely attending delivery. Patients had follow-up during hospital stay, and when examined at 6 weeks for evidence of suture line healing, they were also asked about comfort and resumption of sexual activity. Of 48 patients who had repair with 2-0 chromic suture, 6 were lost to follow-up. Of 44 gravidas who had repair with 2-0 polyglycolic acid suture, 7 were lost to follow-up. At the 6-week postpartum examination, patients with polyglycolic acid sutures had significantly better healing. A noticeable scar was present in 42 of 42 patients with chromic sutures versus 21 of 37 in the polyglycolic acid group, a scar with granulation tissue in 16 of 42 versus 3 of 37, and a gaping scar in 9 of 42 and 0 of 37, respectively. Recovery of function, measured by resumption of sexual activity by 6 weeks, was demonstrated in 1 of 42 patients who had chromic sutures versus 19 of 37 patients who had polyglycolic acid sutures. Episiotomy repair with 2-0 polyglycolic acid (Dexon) offers significant advantages over traditional 2-0 chromic suture, both in terms of wound healing and resumption of normal patient activity, including sexual activity.