Keele & StaffsEpisiotomy Repair

Trainer

Designed and manufactured by Limbs & Things Limited,Sussex Street, St. Philips, Bristol, BS2 0RA, UK.Telephone: +44 (0)117 311 0500 Fax: +44 (0)117 311 0501sales@limbsandthings.com www.limbsandthings.com

L85-127usetvt.qxdIssue 1, March 2006© 2002 Limbs & Things

• Soft skin with a similar drag and strength to human skin• Comprises epidermis, dermal and subdermal layer (not muscle)• Epidermis and dermis have a realistic retention of suture

Stage 3: Perineal Repair Procedures For the practice of episiotomy and second degree tear repair.

Skills • Tissue layer identification and handling• Deep musculature suturing • Subcuticular suturing• Superficial suturing• Identification and management of perineal tears

Features • The Episiotomy & Perineal Repair Procedure Block represents the following realistic anatomy:

- perineal skin- superficial muscle structure and relevant layer for suturing

• Cost effective - all layers can be sutured repeatedly• Each Procedure Block presents 3 repair sites (left lateral is preincised, with both midline and

right lateral uncut)• Skin surface is washable using soap and water • Clamps provided to secure Trainer to edge of bench top

Package supplied• 1 Episiotomy Incision Pad (Pack of 6) Part No: 60451• 1 Episiotomy & Perineal Repair Pad (Pack of 2) Part No: 60452• 1 Episiotomy & Perineal Repair Block Part No: 60453• 1 Perineal Repair Perineum Part No: 60454• 1 Perineal Repair Techniques Jig Part No: 60455• 1 Perineal Repair Base• 1 Perineal Repair Block Clip• 1 Baby Head• 2 bench top clamps

Keele & Staffs Episiotomy Repair TrainerPart No: 60450

A three stage training system for teaching episiotomy, suturing techniques, and repair ofepisiotomy & second degree tears. The model was developed in conjunction with ProfessorChristine Kettle - Professor of Women’s Health, University Hospital of North Staffordshire &Staffordshire University (UK) and Mr Khaled Ismail - Senior Lecturer & Consultant Obstetrician& Gynaecologist, Keele Medical School & University Hospital of North Staffordshire (UK).

Stage 1: EpisiotomyA focussed model for teaching safe methods of performing episiotomies.

Skills • Identification of fontanelles• Handling of a stretched perineum• Reducing the risk of damaging the baby or mother• Use of instruments• Performance of midline or medio-lateral episiotomy

Features • Realistic representation of tissue to represent a stretched perineum• Baby Head provides a realistic look and feel providing landmarks and appropriate tactile

response when inserting fingers to guard the baby’s head• Cost effective with two episiotomies per pad• Attaches to the Perineal Repair Base

Stage 2: Perineal Repair TechniquesBased on our popular Professional Skin Pad (page 26), the Episiotomy & Perineal Repair Padprompts trainees to learn to suture on two planes, one of which has the spatial challengeswhich exists when suturing into the vagina.

Skills (in two planes)• Making an incision• Simple and advanced attempted suturing techniques• Subcuticular undermining• Subcuticular suturing• Continuous suturing

Features• The Episiotomy & Perineal Repair Pad allows suturing techniques to be practised on two

planes• Representation of the anus printed on pad for orientation• Representation of the hymenal remnant printed on pad

to assist in assessment of suturing techniques

Removing the Perineum

1

2

Lift each lower corner,gently peeling the lip of thePerineum from around theedge of the Base.

Once the lip has beenpeeled back past the middleof the Base the Perineumcan be lifted and removedentirely.

1

Gently lift and separate thecentral lug from the Base.

The Perineum should onlybe removed from the basewhen using the EpisiotomyIncision Pad and theEpisiotomy & Perineal RepairPad.

The Perineum can bewashed in warm water witha mild soap.

Dry the lip of the Perineumcompletely before refittingit. A light dusting of talcumpowder on the back willabsorb any residual moistureand make refitting easier.

Perineal RepairTechniques JigPart No: 60455

Baby Head

Components

Episiotomy & PerinealRepair PadPart No: 60452

Perineal RepairPerineumPart No: 60454

Episiotomy Incision PadPart No: 60451

Episiotomy & PerinealRepair BlockPart No: 60453

Perineal Repair Base

Setting up the Episiotomy Incision Pad

2

3

Place the Incision Pad ontoBase by firstly fastening thebottom Velcro® strip to thecorresponding strip on Base.

Then attach the top Velcro®

strip.

2

Slot into position.

1

Place the Base on the worksurface.

Place the Baby Head in theopening within the PerinealRepair Base by lining up thelugs with slots in base.

5

Once an incision has beenmade the Pad can berotated 180 degrees andused again

4

Once in place attach theremaining two strips bystretching the Pad across theBaby’s Head.

Ensure that all four strips aproperly engaged.

3

Setting up the Episiotomy & Perineal Repair Pad

4

3

Fold the tabs at one end ofthe Episotomy & PerinealRepair Pad and insert theminto the hole in the front ofthe Jig.

2

Secure the front of the Jigto the corresponding Velcro®

strips on the Base.

1

Place the Base on the worksurface.

Attach the Perineal RepairTechniques Jig to the Baseby hooking the sucker footthrough the opening thenpushing the tube of the Jigthrough.

5

Fold down the section onthe front of the Jig and pullthe tabs to attach them tothe corresponding Velcro®

strips on the Jig.

Make an incision.

4

Push the Pad through thetube...

...until the tabs are throughto the other side.

6

Ensure that the incision‘gapes’ adequately. If it doesnot adjust the attachmentof the pad by releasing fromVelcro® and re-stretch.

The Jig can also be used onits own if required. Thesucker foot only works on asmooth surface.

5

2

Roll the ends of the lip ontothe Base.

Finally, insert the central luginto the Base.

1

Place the lip of the Perineumcentrally on the top of theBase.

Working downwards, gentlyroll the lip of the Perineumover the edge of the Base.

Ensure all the lugs inside thelip fit into the correspondingindentations in the Base.

Attaching the Perineum

6

3

Apply light pressure to theback of the Block so that itis fully seated within theopening.

Check that the front of theBlock is flush with the insideedge of the Perineum. Ifthere are any gaps push theBlock further forward.

Inserting the Episiotomy & Perineal Repair Block

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2

Gently squeeze the top ofthe Block and push it fullyinto the opening.

1

Insert the bottom of theBlock and push it fully intothe opening.

Ensure that the area of theBlock to be sutured is at thetop, this lines up with therepresentation of the vaginaon the Perineum.

5

If the top of the Block istrapped between the Clipand the base, release it byeasing it forward and down.

The Trainer is ready to beclamped to the worksurface.

4

Now insert the BlockRetaining Clip. This preventsthe Block from falling outwhilst the model is in use.Squeeze the top of theBlock together and slide theClip into the grooves.

With hands placed eitherside of the model, push theClip down with yourthumbs. Do this slowly andfirmly. Finally, push the topof the Clip under theretaining lug.

If the sutures are removedwith care, the tear can beresutured.

Each Procedure Blockpresents 3 repair sites (leftlateral is preincised, withboth midline and rightlateral uncut)

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2

To open the clamp squeezeand hold the small lever onthe bottom jaw.

The jaws will move freelyuntil the lever is released.

1

Place the Trainer on theedge of the work surfaceand secure it in place usingthe two clamps provided.

Place the clamps on the feeton either side of the front ofthe Trainer.

3

To close the jaws squeezethe large lever on thebottom jaw.

Each time the lever issqueezed the jaws movecloser together.

Clamping the Trainer

9