Perineoplasty - grade III–IV (extensive perineal reconstruction)
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Grade III–IV perineoplasty is an invasive gynecological surgical procedure designed to correct severe or extensive perineal changes, commonly following complicated vaginal deliveries, extensive episiotomies, or perineal trauma. The procedure restores the anatomical and functional integrity of the perineum, strengthens the muscles and connective tissues, improves physical and sexual comfort, and enhances the aesthetic appearance of the genital area.
Indications
- Severe perineal insufficiency (Grade III–IV)
- Complete or extensive separation of perineal muscles
- Large post-episiotomy or post-traumatic scar tissue
- Increased diameter of vaginal introitus causing significant functional discomfort
- Markedly decreased sexual satisfaction associated with perineal changes
Procedure & Duration
- Performed in the operating room, usually under general anesthesia
- Controlled incision and excision of extensive scar tissue
- Reconstruction of the perineal muscles and tissue planes
- Layered suturing to restore perineal integrity
- Possible additional posterior or reconstructive colporrhaphy techniques
- Average duration: 60–120 minutes, depending on lesion complexity
Contraindications
- Active genital or perineal infections
- Acute inflammatory diseases
- Severe coagulation disorders
- Pregnancy or immediate plans for conception
- Serious general medical conditions contraindicating surgery
Rehabilitation & Limitations
- Swelling, pain, and mild local discomfort are common in the first days post-surgery
- Relative rest and strict local hygiene are recommended
- Return to work: usually 14–21 days
- Sexual activity and intense physical exertion: prohibited for 6–8 weeks
- Complete recovery: typically 8–12 weeks, depending on procedure complexity
Advantages
- Complete restoration of perineal support and local anatomy
- Reduction of vaginal introitus diameter and improved functional comfort
- Improved aesthetic appearance of the perineal region
- Possible increase in sexual satisfaction
- Personalized intervention for complex lesions with long-term functional and aesthetic results
Sources:
https://www.mdpi.com/2077-0383/13/24/7536?utm_source=chatgpt.com
https://pubmed.ncbi.nlm.nih.gov/22453161/
https://link.springer.com/book/10.1007/978-3-030-97691-0?utm_source=chatgpt.com
Pregătirea:
- Full gynecological consultation and clinical assessment
- Preoperative tests as indicated by the physician (CBC, coagulation profile, infectious disease tests, etc. )
- Informing the physician about ongoing treatments and known allergies
- Adherence to fasting and hydration instructions in case of general anesthesia