PMC7188516_01
The three perineal injuries at examination under anesthesia (EUA) before the perineal repair was performed. (
A
) Case 1; (
B
) case 2; (
C
) case 3.
10-1055-s-0039-1695048-i190484cr-1.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-1.jpg
FI190484cr-1
She was taken to the operating room 45 days after the assault for an EUA ( Fig. 1C ).
The three perineal injuries at EUA after the perineal repair was performed. (
A
) Case 1; (
B
) case 2; (
C
) case 3. EUA, examination under anesthesia.
10-1055-s-0039-1695048-i190484cr-2.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-2.jpg
FI190484cr-2
The colostomy was closed 45 days after the reconstruction; 6 months later she was fully continent of stools ( Fig. 2C ). 
PMC7188516_02
The three perineal injuries at examination under anesthesia (EUA) before the perineal repair was performed. (
A
) Case 1; (
B
) case 2; (
C
) case 3.
10-1055-s-0039-1695048-i190484cr-1.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-1.jpg
FI190484cr-1
She was taken to the operating room 45 days after the assault for an EUA ( Fig. 1C ).
The three perineal injuries at EUA after the perineal repair was performed. (
A
) Case 1; (
B
) case 2; (
C
) case 3. EUA, examination under anesthesia.
10-1055-s-0039-1695048-i190484cr-2.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-2.jpg
FI190484cr-2
The colostomy was closed 45 days after the reconstruction; 6 months later she was fully continent of stools ( Fig. 2C ). 
PMC7188516_03
The three perineal injuries at examination under anesthesia (EUA) before the perineal repair was performed. (
A
) Case 1; (
B
) case 2; (
C
) case 3.
10-1055-s-0039-1695048-i190484cr-1.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-1.jpg
FI190484cr-1
She was taken to the operating room 45 days after the assault for an EUA ( Fig. 1C ).
The three perineal injuries at EUA after the perineal repair was performed. (
A
) Case 1; (
B
) case 2; (
C
) case 3. EUA, examination under anesthesia.
10-1055-s-0039-1695048-i190484cr-2.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-2.jpg
FI190484cr-2
The colostomy was closed 45 days after the reconstruction; 6 months later she was fully continent of stools ( Fig. 2C ). 
With the patient prone, a lone star retractor is positioned to facilitate exposure. The perineal reconstruction is then performed. (
A
) Stay sutures are positioned on the common wall between the rectum and the vagina. (
B
) Using a needle tip diathermy, an incision is made just below the stay sutures and the dissection begins to separate the anterior rectal wall from the posterior vagina.
10-1055-s-0039-1695048-i190484cr-3.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-3.jpg
FI190484cr-3
Figs. 3 - 5 illustrate the key steps of the approach.  Stay sutures are positioned on the common wall between the rectum and the vagina ( Fig. 3A ). Using a needle-tip diathermy, an incision is made just below the stay sutures and the dissection begins to separate the anterior rectal wall from the posterior vagina ( Fig. 3B ).
(
A
) An additional line of stay sutures is then positioned on the vaginal mucosa. Exerting a countertraction on the two suture lines the dissection is continued to separate the rectum from the vagina. (
B
) The separation is only complete when an areolar plane has been reached between two structures.
10-1055-s-0039-1695048-i190484cr-4.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-4.jpg
FI190484cr-4
Figs. 3 - 5 illustrate the key steps of the approach.  An additional line of stay sutures is then positioned on the vaginal wall ( Fig. 4A ). The separation is only complete when the typical fibroareolar plane has been reached that exists between two structures ( Fig. 4B ).
(
A
) The perineal body is then reconstructed with interrupted absorbable sutures and the sphincter complex is reapproximated. (
B
) Reconstruction is completed with an anoplasty of the anterior rectal wall which is sutured to the reconstructed perineal body. The skin is then closed with interrupted absorbable sutures.
10-1055-s-0039-1695048-i190484cr-5.jpg
PMC7188516_03_10-1055-s-0039-1695048-i190484cr-5.jpg
FI190484cr-5
Figs. 3 - 5 illustrate the key steps of the approach.  The perineal body is then reconstructed with interrupted absorbable sutures and the sphincter complex is reapproximated ( Fig. 5A ). The skin is then closed with interrupted absorbable sutures ( Fig. 5B ). 