Handbook On Field Veterinary Surgery (VetBooks - Ir) PDF

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Handbook on
Field Veterinary Surgery
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THE EDITORS
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Dr. M.M.S. Zama obtained his professional degree of B.V.Sc & A.H. in 1983 & M.V.Sc. (Vet. Surgery) in 1985 from G. B.
Pant University of Agriculture and Technology, Pantnagar. He joined as Assistant Professor (Surgery and Radiology) in December,
1986 at S. K. University of Agricultural Sciences and Technology, Srinagar. During this period, he obtained his Ph.D. degree in 1995
from IVRI, Izatnagar. He was elevated to Associate Professor in 1998 and to Professor in 2006. He joined as Head, Division of
Surgery, Indian Veterinary Research Institute, Izatnagar in May, 2009 and as Dean, Faculty of Veterinary Sciences & Animal
Husbandry, Sher-e-Kashmir University of Agricultural Sciences & Technology of Jammu in December 2014.
Dr. M. M. S. Zama has a teaching, research, extension and administrative experience of more than 28 years in the University
and National Institute. He received National Merit Scholarship, ICAR Junior Research Fellowship, ICAR Senior Fellowship during
his studies. He was awarded Vice Chancellor’s Gold Medal and Jawaharlal Nehru Trust award for his academic excellence. He co-
authored nine laboratory manuals, one guide and one information bulletin for undergraduate students He guided 1 Ph.D. and 5
M.V.Sc. students. He served as member of various interview committees constituted for selection of State Veterinary Officers,
Faculty and other staff positions of universities and institute.
Dr. Zama published more than 100 research papers, review and technical articles in international and national journals, received
many best paper presentation awards of professional Societies and evaluated research project proposals submitted to DST, DBT,
ICMR and CAU, SAUs. During his illustrious career at SKUAST-Jammu and at IVRI, Izatnagar, he has been associated with 13
institute and 3 outside funded research projects in the areas of anaesthesia, physiotherapy, soft tissue surgery, orthopaedic surgery,
acellular graft, stem cell therapy and wildlife and made significant contribution in these areas. He along with other scientists patented
4 surgical designs.
Dr. Zama conducted a number of training courses and symposia for the Faculty and Field Veterinarian. He is member of
various Sectional Committees of MHDC, Bureau of Indian Standards, New Delhi. He served as Chairman, Board of Studies and the
Member of Academic Council, Research Council and Extension Council of the University/Institute. He has delivered many expert
lectures and has been referee to various international and national scientific journals. Dr. Zama was elected as Fellow of National
Academy of Veterinary Sciences (NAVS) and Indian Society for Veterinary Surgery and is life-member of various Professional
Societie s.
Dr. Hari Prasad Aithal graduated from Veterinary College, Bangalore (1989), and obtained M.V.Sc. (1991) and Ph.D.
(1997) degrees from Indian Veterinary Research Institute, Izatnagar (UP). Dr Aithal started his professional career as Scientist in
the Division of Surgery at IVRI in 1993. Subsequently he was promoted to the post of Senior Scientist in 2002, and Principal
Scientist in the year 2009. During 21 years’ of illustrious career, he has been actively involved in research, post-graduate teaching
and extension activities. He has been the Principal Investigator or Co-investigator in 20 research projects funded by different
agencies. His contribution has been significant in the field of Orthopaedic Surgery and Regional Anaesthesia in ruminants. He has
published more than 220 research papers in scientific journals of repute,
including 50 papers in renowned International Journals. He has also submitted 02 Patents and 06 Designs on novel fracture
fixation techniques/devices in animals.
Dr. Aithal is the Associate Editor of Indian Journal of Veterinary Surgery since 2002, and is an external reviewer for several
international and national journals. He has co-edited a Text Book on Anaesthesia and Analgesia for Veterinary Graduates, several
Laboratory Manuals, Monograph, Annual Reports, Souvenirs and Compendium of Abstracts. He has been a guide to 4 Ph.D. and 6
M.V.Sc. students, and acted as external examiner for UG/PG courses/thesis evaluation/viva-voce examination of PG students of
several universities.
Dr. Aithal has won many awards and honours, including Best Teacher Award of the Deemed University, IVRI, Fellowships of
the National Academy of Veterinary Sciences and Indian Society for Veterinary Surgery, S.J. Anjelo Memorial Gold Medal
for best paper published in Indian Veterinary Journal, Dr. A.K. Bhargava Memorial Gold Medal for the best papers published in
Indian Journal of Veterinary Surgery (twice), besides several Best Paper Presentation awards at National Conferences.
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Dr. A.M. Pawde obtained his B.V.Sc. & A.H. in 1987 and M.V.Sc. Vet. Surgery from Nagpur Veterinary College, in 1990.
He joined as a scientist at Division of Surgery, IVRI, Izatnagar in 1991. He obtained his PhD degree in 1998. He was recipient of
ICAR JRF in 1997 and CSIR SRF in 1994. He was promoted to Senior Scientist in 2000 and Principal Scientist in 2008. He has
many awards and honours to his credit including fellowship and best paper presentation of Indian Society for Veterinary Surgery,
and Rummy Ramchandran Memorial Gold Medal Award for the best paper published in Indian Veterinary Journal in the field of
Oncology (twice) i.e. 1997 and 1999.
Dr. Pawde has been expert member in the committee of wild life, Ministry of Environment & Forests, Indian Bureau of
Standards, New Delhi and member, UPPSC, Allahabad, Coordinator, Referral Veterinary Polyclinics, IVRI, Izatnagar. He has been
a team member of T’sunami rehabilitation team sent by Director, IVRI. He has delivered many expert lectures, radio talks and TV
Interviews. He had been referee to various scientific journals. Dr. Pawde is a life member of various professional societies. During
his academic and professional career he actively participated in games, dog shows and horse shows (endurance). He has presented
120 papers and published 110 papers in International and National Journals of repute. Dr. Pawde has the credit of guiding 8 masters
and 2 Ph.D. students. During his illustrious career at IVRI he has been associated with nine research project including the Principal
Investigator of two projects. He made significant contribution in the areas of veterinary acupuncture with special reference to
paralysis in dogs and arthritis in buffaloes.
Handbook on
Field Veterinary Surgery
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— Editors —
Dr. M.M.S. Zama
Dr. H.P. Aithal
Dr. A.M. Pawde
2016
Daya Publishing House®
A Division of
Astral International Pvt. Ltd.

New Delhi – 110 002
© 2016 EDITORS
Publisher’s note:
Every possible effort has been made to ensure that the information contained in this book is accurate at the time of going to
press, and the publisher and author cannot accept responsibility for any errors or omissions, however caused. No
responsibility for loss or damage occasioned to any person acting, or refraining from action, as a result of the material in
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this publication can be accepted by the editor, the publisher or the author. The Publisher is not associated with any product
or vendor mentioned in the book. The contents of this work are intended to further general scientific research,
understanding and discussion only. Readers should consult with a specialist where appropriate.
Every effort has been made to trace the owners of copyright material used in this book, if any. The author and the
publisher will be grateful for any omission brought to their notice for acknowledgement in the future editions of the book.
All Rights reserved under International Copyright Conventions. No part of this publication may be reproduced, stored in a
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without the prior written consent of the publisher and the copyright owner.
Cataloging in Publication Data—DK

Courtesy: D.K. Agencies (P) Ltd. <[email protected]>
Handbook on field veterinary surgery / editors, Dr. M .M .S. Zama, Dr. H.P. Aithal, Dr. A.M . Pawde.
pages ; cm
Contributed articles.
Includes index.
ISBN 9789351307914 (Ebook)
1. Veterinary surgery-India-Handbooks, manuals, etc. I. Zama, M . M . S., editor. II. Aithal, H. P. (Hari Prasad), editor. III. Pawde, A. M , editor.
DDC 636.08970954 23
Published by : Daya Publishing House ®

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Printed at : Thomson Press India Limited

Dr. Amresh Kumar
B.V.Sc. & A.H., M.V.Sc., Ph.D. (Ill., U.S.A.)
FNAAS, FISVS, FNAVSC
(Ex-Dean, C.VA. Sc., Pantnagar)
Director General, KCMT
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Foreword
I am happy to note that a ‘Handbook on Field Veterinary Surgery ’ has been edited by Dr. M.M.S. Zama, Dr. H.P. Aithal
and Dr. A.M. Pawde. Veterinary Surgery has made significant advancements during last few decades. Surgical operations which
were considered difficult to be done in the field, are being commonly performed on animals, be it for disease of eye, heart, lungs,
bone and joints, teat and udder; with great ease and success. Non-invasive diagnostic and imaging techniques have revolutionized the
diagnosis and treatment of surgical diseases. The fruits of these developments need to be transferred to end users, the live-stock
farmers, to increase livestock productivity. This handbook is an attempt ill this direction. The editors have tried to compile the
relevant and very useful information on practical aspects of general and operative surgery on recent developments on asepsis and
sterilization, suture and suture techniques and basic consideration for surgery. These are to be taken into account to undertake
surgery under field consideration, where facilities for major operations are inadequate. Besides practical information on management
of surgical diseases, various types of surgical techniques for castration, aural haematoma, ovariohysterectomy, esophagostomy,
tracheostomy, hemiorrhaphy, treatment of various types of fractures, foreign body syndrome; and basic eye affections have been
written by eminent veterinary surgeons from leading Institutions.
I am confident that this Handbook will prove to be a useful aid for the field veterinary surgeons and will also become a ready
reckoner for them. It will surely help in managing the various surgical disorders effectively and efficiently and will reduce livestock
morbidity and mortality due to surgical ailments.
I would like to congratulate Dr. M.M.S. Zama, Dr. H.P. Aithal and Dr. A.M. Pawde (Editors) for publication of this Handbook
on Field Veterinary Surgery. I wish them good luck for all their endeavours.
Amresh Kumar
Director General
KCMT
Preface
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The number of surgical conditions being reported in veterinary hospitals is ever increasing due to changing socioeconomic
status of urban as well as rural India, growing industrialization, increased vehicular traffic and also greater awareness among the
livestock and pet owners about the treatment options available. Though the modern advanced techniques, facilities and expertise are
available in established veterinary institutes and college hospitals across the country, most of the time they are beyond the reach of a
common man. Many a times, animal owners expect their animals to be treated at their doorstep, wherein the role of field veterinary
surgeon becomes important. Relatively less expertise and technical assistance available, coupled with poor veterinary infrastructure
and facilities at village levels make the job of a field veterinarian challenging and demanding. Apart from attending general health
problems of livestock, he is also expected to treat common surgical conditions routinely encountered in animal patients.
With the advent of newer diagnostic and surgical techniques, which can be adapted in field conditions, along with easy access
to internet facility at every remote corner, the face of field surgery is changing. Further, more and more postgraduates, especially
from clinical disciplines are entering into field service, making it possible to undertake specialized surgeries at the field level. Many
surgical conditions can be treated in the field by maintaining minimum standards of surgery with least facility; mostly it is the
confidence and skill of the surgeon that determine the outcome of a surgical intervention. In order to develop confidence and surgical
skill, however, one has to keep abreast with the latest developments in the related areas of diagnostic imaging like X-rays and
ultrasonography, anaesthetic protocols, and surgical techniques. Though there are several text books which describe different
surgical techniques, they are very exhaustive and not readily accessible to a field vet. Hence, there was a need to have a hand book,
which can act as ready reference for the field veterinary surgeons, describing simple surgical techniques which are easy to
understand and practice.
The contents of this book are specially designed keeping in view the needs of veterinary surgeons working at the field level.
The book provides concise but comprehensive hands on information on a variety of surgical conditions commonly encountered in
different domestic animals. The contents have been written from different authors, who are experienced surgeons and teachers
engaged in day to day clinical practice, and are experts in the particular field. The book contains the basic information, and the
techniques are described in simple language, which can be easily understood by a veterinary surgeon with limited subject knowledge.
The handbook contains 23 chapters comprising almost all the surgical conditions encountered in the field. Prospects and basic
considerations in field level surgery, methods of sterilization, suturing techniques and materials are comprehensively described in the
initial chapters. Common surgical techniques like management of wounds, tumours, urolithiasis, castration in different species of
animals, ovariohysterectomy in bitches and caesarean section in large animals have been described in subsequent chapters. This was
followed by specific soft tissue surgeries like oesophagotomy, tracheotomy/tracheostomy, foreign body syndrome, intestinal surgery,
hernia repair, rectal prolapse, atresia ani and recti, which have been detailed considering their importance in the field level. Simple
techniques for management of horn injuries, bone fractures, tendon injuries, patellar desmotomy and foot affections are described in
the following chapters. At the end, surgery of teat, ear haematoma and eye affections have been covered. The chapters on different
surgical conditions describe basic considerations, instrumentation, anaesthesia, surgical technique, and pre- and post-operative care
of animals with the help of diagrams or/and photographs. More emphasis was given to the easy-to-do surgical techniques, which are
common and can be performed at the field level with limited facilities and assistance. Hence the book is a ready reference to all the
field veterinary surgeons and fresh veterinary graduates who wish to pursue their career as veterinary surgeons in the field. The
hand book can play a great role in updating the knowledge, building confidence and refreshing the skill of the field veterinarians. We
hope that the book will help in bringing a perceptible change in the field veterinary surgery in days to come.
We earnestly thank all the contributors who have contributed chapters in the book, without their active support it would not be
possible to bring out this compilation.
Dr. M.M.S. Zama
Dr. H.P. Aithal
Dr. A.M. Pawde
Contents
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Foreword
Preface
List of Contributors
1. Prospects and Recent Advances in Field Level Surgeryin Livestock

M.M.S. Zama
2. Basic Considerations for Field Level Surgery

General Considerations – Pre-Surgery Meeting – Sterilization of Surgical Instruments or Supplies – Records –
Physical Examination – Food and Water – Pediatrics – Thermoregulation – Emergency Preparation – Surgical Risk
Patients – Minimum Surgeon Knowledge Base – Conclusions.
Gaj Raj Singh
3. Asepsis and Sterilization

Principles of Surgical Asepsis – Prevention of Surgical Infections – Common Antiseptic Agents – Sterilization of
Surgical Equipment/Instruments – Physical Methods – Chemical (Gas) Sterilization – Ionizing Radiation – Cold
Chemical Sterilization.
Hakim Athar and B.A. Moulvi
4. Sutures and Suturing Techniques

Properties of an Ideal Suture – Classification – Suture Techniques.
M.M.S. Zama
5. Management of Wounds
Type of Wounds – General Management of Wounds – Complications of Wound Healing – Topical Wound Medication –
Bandaging – Abscess – Factor Affecting Wound Healing.
A.M. Pawde
6. Mangement of Tumours
Type of Tumours – Diagnosis – Prognosis – Treatment – Canine Mammary Tumour (CMT) – Diagnosis – Clinical
Staging of Canine Mammary Carcinoma (WHO Classification) – Treatment – Prognostic Factors – Complications.
S.K. Maiti
7. Affections of Horns
Anatomy – Restraint – Anaesthesia – Technique for Dehorning – Complications – Horn Avulsion – Horn Cancer.
Aswathy Gopinathan and Kiranjeet Singh
8. Aural Haematoma in Dogs

J. Mohindroo
9. Management of Basic Eye Affections in Animals

Ocular Worms – Entropion – Ectropion – Cherry Eye – Dermoids – Foreign Bodies in the Eye – Traumatic Ocular
Proptosis – Ocular Tumours – Basic Ophthalmic Surgery Pack for Small Animals – Miscellaneous Basic Ophthalmic
Items.
S.P. Tyagi
10. Tracheostomy and Oesophagotomy in Cattle
Tracheostomy – Indications – Surgical Anatomy – Anaesthesia and Control – Site of Incision – Surgical Procedure –
Postoperative Care – Complications – OESOPHAGOTOMY – Indications – Surgical Anatomy – Anaesthesia and
Control – Site of Incision – Surgical Procedure – Postoperative Care – Complications – Special Considerations.
Ajay Kumar Gupta
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11. Foreign Body Syndrome in Bovines

Pathogenesis – Diagnosis – Differential Diagnosis – Treatment.
R.N. Chaudhary
12. Medial Patellar Desmotomy

Indications – Etiology/Predisposing Factors – Symptoms – Clinical Examination – Anatomy of Stifle Joint – Surgical
Procedure – Postoperative Care – Possible Postoperative Complications.
Abhishek Chandra Saxena
13. Surgical Management of Intestinal Obstruction

Etiology – Pathophysiology – Clinical Signs – Diagnosis – Surgical Treatment – Intussusception Bypass Surgery.
H.R. Bhardwaj
14. Ventral Herniorrhaphy

Treatment – Postoperative Management – Open Reduction of Hernia.
A.K. Sharma
15. Atresia Ani and Rectovaginal Fistula

ATRESIA ANI – Etiology – Symptoms – Diagnosis – Surgical Treatment – Postoperative Care – Prevention –
RECTOVAGINAL FISTULA – Etiology – Diagnosis – Surgical Management – Postoperative Care – Prevention.
Prakash Kinjavdekar
16. Perineal Laceration and Rectal Affections

PERINEAL LACERATION – Indications – Equipments – Preparation and Positioning – Procedure – Postoperative Care
– Expected Outcome – Complications – RECTAL PROLAPSE – Etiology – Diagnosis – Treatment – RECTAL (SUPRA)
ABSCESS – Etiology – Symptoms – Diagnosis – Prognosis – Treatment.
Kiranjeet Singh and Aswathy Gopinathan
17. Management of Urolithiasis in Ruminants

Surgical Managements of Urolithiaisis in Goats and Calves – Surgical Managements of Urolithiasis in Bullocks
T.B. Sivanarayanan and Amarpal
18. Castration of Male Animals

Ruminants (Cattle, Sheep, Goat) – Equine and Small Animals.
M.R. Fazili
19. Ovariohysterectomy in Canines and Felines

Indications – Surgical Anatomy – Surgical Procedure.
A.K. Gangwar and Kh. Sangeeta Devi
20. Caesarean Section

Indications – Surgical Anatomy – Anaesthesia – Surgical Technique – Postoperative Care.
Rekha Pathak
21. Management of Fractures

Diagnosis of Fracture – First Aid – Factors to be Considered Before Fracture Fixation – External Fixation Techniques
– Plaster Cast – Modified Thomas Splints – External Skeletal Fixation Techniques – Transfixation Pinning and Casting
– Acrylic and Epoxy-Pin Fixation Systems.
Hari Prasad Aithal
22. Tendon Surgery

Tendon Morphology – Tendonitis – Principles of Tendon Surgery – Tendon Suturing Techniques – Contracted
Tendons – Treatment.
A.M. Pawde
23. Teat Surgery

Anatomy – Restraint and Anaesthesia – Diagnosis – Preparation for Surgery – Surgical Diseases – Recent Trends in
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Teat Surgery.
Mozammel Hoque
Index
List of Contributors
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Aithal, H.P.
Principal Scientist, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, U.P.
Amarpal
Athar, Hakim
Associate Professor (Surgery), Faculty of Veterinary Sciences & AH., SKUAST-Jammu, J&K
Bhardwaj, H.R.
Chaudhary, R.N.
Assistant Professor (Surgery), COVS, LLRUVAS, Hisar, Haryana
Devi, Kh. Sangeeta

Associate Professor, College of Veterinary Sciences & AH, NDU&AT, Kumarganj, Faizabad, U.P.
Fazili, M.R.
Gangwar, A.K.
Associate Professor, College of Veterinary Sciences & AH, NDU&AT, Kumarganj, Faizabad, U.P.
Gopinathan, Aswathy
Scientist, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, U.P.
Gupta, Ajay Kumar

Hoque, Mozammel
Kinjavdekar, Prakash
Maiti, S.K.
Mohindroo, J.
Associate Professor (Surgery), College of Veterinary Sciences, GADVASU, Ludhiana, Punjab
Moulvi, B.A.
Professor and Head (Surgery), Faculty of Veterinary Sciences & AH., SKUAST-Jammu, J&K
Pathak, Rekha
Senior Scientist, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, U.P.
Pawde, A.M.
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Saxena, Abhishek Chandra

Scientist, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, U.P.
Sharma, A.K.
Singh, Gaj Raj

Former Head, Division of Surgery, Indian Veterinary Research Institute, Izatnagar and Former Dean, College of
Veterinary Sciences & A.H. Selesih, Aizawl, Mizoram
Singh, Harnam
Dean, College of Veterinary Sciences & AH, NDU&AT, Kumarganj, Faizabad, U.P.
Singh, Kiranjeet
Senior Scientist, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, U.P.
Sivanarayanan, T.B.
Ph.D. Scholar, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, U.P.
Tyagi, S.P.
Associate Professor, Department of Surgery and Radiology, CSKHPAU, Palampur, H.P.
Zama, M.M.S.
Professor and Head, Division of Surgery, Indian Veterinary Research Institute, Izatnagar, U.P.
1
Prospects and Recent Advances in Field Level Surgery
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in Livestock
M.M.S. Zama
From the start of civilization, human beings have utilized different animal species for a variety of purposes viz. food, apparel,
drought power, companionship, entertainment, research experimentation, security etc. Livestock wealth is deemed as the oldest
wealth resource for mankind and is still considered as a symbol of economic status in the rural society. Livestock sector plays a
significant role in the Indian economy. Contribution of livestock to agricultural gross domestic product (Ag GDP) has been rising; it
increased from 14 per cent in 1980-81 to 24.7 per cent in 2009-10 (MoA, 2011). Of the total household in the rural area, about 73
per cent own some form of livestock.
Increasing colonization, industrialization and traffic has lead to a drastic increase in the surgical affections of the livestock. As
most of the livestock owners are small and marginal farmers, such problems add to the economic burden on already overloaded
farmers. Veterinary surgeons are not directly concerned with the production aspect of livestock but surgical interventions are many
a times required to salvage or prolong the life of an animal having good production potential or to improve the work efficiency of
drought animals. Sometimes palliative surgery is required to reduce the sufferings of the animal. Because of the obvious constraints
associated with transport, handling and restraint of livestock species together with the poor veterinary infrastructure in rural India,
which is the principal beneficiary, role of veterinary surgeons becomes very challenging and demanding. Most of the times, animal
owners want veterinary aid at their doorstep.
Field veterinarians successfully deal with many minor surgical affections in livestock, like opening an abscess or cyst,
castration, shearing of over grown horn, application of plaster cast and suturing of wound. However, surgical interventions like
amputation of tail, suturing teat fistula, caesarean section, fracture management, amputation of horn, urethrotomy, cystotomy,
removal of eye worm, rumenotomy, amputation of rectal or vaginal prolapse, patellar desmotomy, modified gastrocnemius tenectomy
and excision of tumour etc. require a great level of confidence and skill.
Various problems associated in the diagnosis and management of surgical affections at field level include:
Lack of proper infrastructure such as operation theatre, protective clothing, aseptic techniques, availability and
accessibility of basic surgical instruments and sterilization facilities.
Lack of proper diagnostic modalities such as radiography, ultrasonography and fluoroscopy etc.
Most of the surgical interventions in livestock involve higher cost which overrides the economic value of the animal.
Post-operative management and care of the animal is difficult due to lack of knowledge and ignorance on the part of
farmer.
Availability of life saving and emergency drugs is limited as they are rarely used and are costly.
Lack of skilled staff necessary for assistance during various surgical interventions.
Most of the animals are presented in advanced conditions (e.g. caesarean section) due to the lack of knowledge regarding
seriousness of the problem.
However, with recent developments in the field of veterinary clinical sciences, a new era is in its phase of inception, where high
quality diagnostic and therapeutic modalities will be available to the animal owners at the remotest of villages at substantially
affordable prices. Portable hand held X-ray machines can be taken to the farmer’s doorstep for proper diagnosis of fracture cases.
With the help of internet, the radiographs can be shared with a specialist sitting far away in any corner of the country for diagnosis
and advice on surgical intervention.
Ultrasound once considered as a luxury has now emerged as the most versatile diagnostic imaging modality. Portable, battery
operated ultrasound machines with advanced imaging options like colour and pulse Doppler are available at highly affordable prices
and are being installed at State Veterinary Facilities. They can not only revolutionize the diagnostic services at field level, but can
also significantly improve the accuracy of pregnancy diagnosis in livestock, which can be a boon to the farmers. Cases of reduced
reproductive performance can be diagnosed very efficiently with ultrasound examination and this will not only help in proper
management of such cases but also drastically reduce the cost of treatment.
Laparoscopy and endoscopic machines have also become affordable and if installed at District level, they can work wonders in
cases where it is difficult to access and image an organ. Animals suffering from conditions like oesophageal or tracheal obstruction,
intestinal obstruction etc. can be very efficiently managed with these techniques. Imaging techniques like CT scan and MRI are still
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farfetched things in the veterinary field but one day they will be as easily accessible to veterinary patients as they are to human
patients today.
Surgical techniques have also come a long way in recent years. Many advances have taken place in the areas of
gastrointestinal, respiratory, urogenital, cardiovascular, ophthalmic, orthopaedic and neurosurgery. Animals suffering from urinary
obstruction were doomed as surgery was considered very difficult in field conditions, but newer techniques like tube cystostomy has
emerged as a life saver for these animals without taxing the veterinarian, animal or its owner. Compound fractures almost always
rendered the animal unproductive but with the advent of newer techniques of external skeletal fixation which can be customized
according to the size of animal and site of fracture, this condition can be successfully managed most of the time. Another advantage
of these techniques is their cost effectiveness and they do not put much economic burden on the livestock owners.
Hernia is a very commonly encountered condition in large animals at field conditions. Most of them can be corrected with the
help of conventional treatment techniques, but sometimes they are either too big to be repaired conventionally or the surrounding
muscles are too weak to hold the sutures. In such cases use of grafts is warranted. Research on this line is already on and the day is
not far when xenogenic, non-immunogenic, ready to use grafts for veterinary patients will be commercially available at affordable
price. Advanced treatment techniques, like total hip joint replacement, lens transplantation etc., are also done more frequently in
India.
Newer treatment concepts like use of healing promoters, mesenchymal stem cells and cell seeded implants are also finding
their way in the routine treatment of various surgical disorders like fractures, dislocations, burn injuries, osteoarthritis and nerve
injuries. These techniques are easy to use, and with slight modifications can be used at field level. In the near future they may also
appear in ready to use packages for direct application.
Physiotherapy is one of the fastest developing fields in the veterinary as well as medical sciences. Research on newer
physiotherapeutic modalities like interferential nerve muscle stimulation, static magnetic therapy, diathermy, electro-acupuncture etc.
have shown some promising results in various conditions affecting different animal species. Physiotherapy is not solely indicated in
neuromuscular disorders but it can be used for rehabilitation of surgical patients, thereby reducing their sufferings and time of
functional recovery. These modalities are not very costly and can be easily applied at the field level with minimal training and
expertise.
Surgery is an ever evolving field and newer advances are frequently overcoming the limitations of field level surgery but basic
principles of surgery as stated by Halsted still stand true. Surgery at field level is probably more dependent on the will power and self
confidence of the surgeon. Veterinary facilities at the field are fast improving and it is the duty of the veterinarians to keep pace with
these changes through continual improvement in their professional competence and skill and keeping abreast of recent advances.
2
Basic Considerations for Field Level Surgery
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Gaj Raj Singh
The veterinarians are expected to help the community to make use of animal resources fully and in a sustainable manner.
Therefore, a veterinarian is supposed to perform several tasks such as handling, examining and treating all species of animals;
carrying diagnostic tests including X-rays and ultrasound scans; immunizing animals against different types of diseases; performing
surgery including managing anaesthesia; maintaining up to date records and many other nondescript tasks. In order to perform these
tasks effectively, he/she has to keep himself/herself abreast with the latest technical developments in different areas including
surgical techniques, X-rays, ultrasound and anaesthetic protocols. Therefore, continuing education can play great role in updating the
knowledge and refreshing the skill of the field veterinarians.
The basic principles of surgery are the same for pet and farm animals. The goal of veterinary surgery are, however, quite
different in pets and in farm animals. In the former situation, surgery is a bit like in human beings, and more and more complex
operations are performed, with sophisticated anaesthesia techniques. The Small Animal Surgery involves providing the highest
quality care available. Facilities such as ultrasonography, digital radiography, computed tomography, and magnetic resonance imaging
to aid in diagnosis of pet’s condition are now used in veterinary practice. Advanced surgical treatments, including repair of
complicated fractures, minimally invasive surgery (arthroscopy and laparoscopy) and spinal surgery are now available for pets.
In farm animals, which we deal at field level, the techniques used for small animals can be practiced; however, the cost of the
operation must not exceed the economic benefit in surgically treating the illness. Therefore, while planning the basic requirements for
field level surgery, one has to maintain standards of surgery yet keep the cost of surgery within limits for positive outcome.
The clinics designed to function in the remote areas require attention to minimally acceptable standards to adequately and
safely perform surgery. Although specific protocols may vary depending upon many factors, there exists a minimally acceptable
level which all clinics should mandate. This ensures safety and well-being of animals and clinical staff, and maintains quality controls
over service delivered. The standard applied to the patient on the day of surgery will affect the immediate outcome of the patient as
well as long after the patient has recovered from surgery. Minimally acceptable standards should be established, met and followed
for each specific programme. It is important that all the staff acknowledge the seriousness of anaesthesia and surgery on every
individual patient.
General Considerations
Surgery is a team work; therefore, communication with the local veterinary community in the area may enhance the
overall effectiveness and outcome of the surgery.
The language skills are imperative for communication. If you can speak in local language that may help in understanding
the case and in giving proper post-operative direction to the owner.
You should know your case. Surgery should not be considered as luxury, way to demonstrate your ability, earn money or
impress others. One should decide to undertake the surgery when it is the only option left to treat the case. Otherwise, it
may prove disastrous if wrong decision is taken. In cases where surgery is unavoidable, it should be planned and
executed as early as possible.
You should know yourself. Have you operated such cases earlier? Are you prepared to meet any complication that may
arise during surgery? If yes, go ahead with confidence. If not, do not hesitate referring the case to the nearest clinic,
where facilities for operating such cases are available or request a friend, who is competent to operate the case. Read
the surgical procedure carefully in a good book prior to operating the case.
You should know your facilities. Make the list of inventories needed during surgery and emergency. If anything is missing,
it is better to arrange well in advance before the start of surgery.
Check the cleanliness. Although surgery can be performed anywhere, cleanliness of the area should be established and
maintained as best as possible. Operations often performed outdoors yet should not excuse attention to cleanliness.
Address cleanliness prior to the start of any surgery.
Check whether running water supply is available or not. If not arrange/ obtain adequate water holding container for
cleaning of instruments, preparation of patient and surgery team, cleaning of table etc.
Check for the availability of electricity. If no electricity is available or there is possibility of power breakdown, arrange
suitable power backup for equipments.
Check for lighting. If the natural light on the site is sufficient. Adjunct lighting should be available for early morning, late
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afternoon or evening surgery and cloudy days.

Protection from sun, rain and wind must be addressed if surgery is performed outdoors.
During winter additional source of heat may be needed to be supplied for surgery, recovery or ill cases.
Facilities for trash collection and disposal and for disposal of biohazard material.
Spays and castrations are almost elective procedures. The risks versus the benefit of surgery must be considered in each
case with the final decision with the owner.
Pre-Surgery Meeting
It is always advisable to arrange an additional meeting with all the team to discuss analgesic, anaesthetic and surgical protocols,
emergency protocols and approach to possible surgical complications.
Sterilization of Surgical Instruments and Supplies

Sterilization of surgical instruments and supplies is an essential component for successful outcome of the surgery. Method to
sterilize instruments and supplies should be determined in advance of the surgery. Many veterinary hospitals/ dispensaries may not
have access to autoclave although they may have access to pressure cooker. An autoclave or pressure cooker will kill all the viable
organisms including spores when done at the correct time and temperature (121degree centigrade at 15 pound pressure for 30
minutes). Autoclaves are expensive and usually difficult to maintain or repair in remote locations. Pressure cookers lend themselves
well to remote work. They are relatively cheap and easy to maintain. They can be purchased either electric or gas.
Although steam sterilization is recognized as the preferred method of sterilization of equipment and supplies, chemical
disinfection, when proper instructions are followed, is an acceptable method for disinfecting instruments for surgical procedures.
Disinfecting solutions kill most microorganisms except spores when done properly and according to manufacturer’s
recommendations. It is important to understand the chemical properties of the specific disinfecting solution in order to avoid side
effects such as chemical peritonitis. There is a large product list based on germicidal activity (high to low). Several commercial
products such as Cidex, Benz All or Surgical Crit are available. Minimally acceptable standards for chemical disinfection are:
Solution prepared to manufacturer’s instructions
Instruments clean and dried
Total immersion
Unclamped
Timed according to manufacturer’s instructions
Removed with sterile haemostat
Records
A record is required on every animal admitted to the clinic. Records provide a written log of patient, owner data and physical
parameters with which to decide if the animal is a surgical candidate. Feral or extremely aggressive animals must have a record
even if they cannot be examined prior to sedation and/or anaesthesia and their status noted on the record. Feral or extremely
aggressive animals are examined after sedation or anaesthesia, prior to surgery.
Physical Examination
All animals must receive a physical examination prior to undergoing anaesthesia and surgery. Exceptions to this will be feral or
extremely aggressive animals. Often field clinics are held in impoverished areas. A record and physical examination demonstrates
the care, dedication and respect each animal receives and establishes a good reputation within the community. This in turn often
increases the value and worth of the animal in the owner’s eyes and the value of the veterinarian in the community’s eyes.
Many animals in field may not be in the best of health. Often no preoperative diagnostics are available. A good physical
examination may identify potential problems which can be addressed accordingly, minimizing complications. The findings on physical
examination will determine the appropriate anaesthetic and surgical protocols. Pediatric, geriatric, pregnant or metabolically
compromised animal will need special planning.
Minimal Data to be Recorded

Temperature.
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Pulse rate and quality.

Respiration rate and lung sounds.
Capillary refill time and mucous membrane colour and texture.
Examination of all other systems for clinically relevant findings.
An accurate weight is needed to calculate the correct dose of any medication to be administered. A baby scale or fish
scale can be used in animals under 4.5 kilograms. Aweight scale can be used for animals greater than 4.5 kilograms.
It is also important to consider body condition score (BCS) with regard to analgesic and anaesthetic dosing. Certain
medications, especially anaesthetics, are more accurately dosed and are metabolized based on lean body weight versus
overall body weight. Experienced staff should assign a BCS score to more effectively address analgesia and anaesthesia.
Food and Water

Normal preoperative instructions are to withhold food for eight hours prior to admission to the clinic. It is not needed, nor
recommended to withhold water prior to admission, especially as the environment of a field clinic can contribute to dehydration.
Paediatrics
Paediatric patients are defined as a patient less than 16 weeks of age. Although normal pre-operative instructions are to
withhold food for 8 hours prior to surgery, paediatric patients are the exception to this advice. They are much more prone to
hypoglycaemia. They may not be taken to surgery for hours after presentation. Their complete eating history may not be known.
Paediatric patients should be fed two to four hours prior to surgery. If surgery is done within two hours of presentation, their blood
glucose level can be augmented by giving honey. Glucose/ dextrose solutions should never be given by any other route than
intravenously or orally.
Thermoregulation
Ambient temperatures in a field clinic can range from extremely cold to very hot. Anaesthesia and surgery disrupt the normal
thermoregulatory mechanisms and typically cause the patient to become cold. Inattention to thermoregulation of the patient produces
significant and often avoidable complications and it is the most common post-operative complication. Methods to address
thermoregulation include:
Monitoring temperatures intra-operatively and in recovery.
The use of a digital thermometer in the nostril intra-op gives a general idea of body temperature.
Placing material between the animal and table surface such as newspaper, bubble wrap or a dry towel.
Warm, ambient temperatures are not conveyed to the table surface. The material of the table surface may contribute to
an already disrupted thermoregulatory mechanism.
Cool or cold ambient temperatures can worsen this and may require additional attention to thermoregulation. In addition,
heat loss from an animal to the table surface can be significant, even if the ambient temperature is high. This is especially
important in cats, small dogs and paediatric patients.
Keep patients warm and dry. Wet animals are much more prone to hypothermia.
Keep heat sources available such as socks filled with rice and warmed in a microwave, warm water bottles, heating pads
etc.
Never put a heat source directly against an animal’s skin as they are very easy to burn.
Minimize the use of water and cold prep solutions. Excess prep liquid should not be squeezed on to the surgical surface.
Alcohol greatly and rapidly lowers body temperature. Routine use is not recommended.
Intravenous or subcutaneous fluids. Fluids at room temperature are colder than a normal animal’s body temperature and
can contribute to hypothermia. Warm subcutaneous fluids may help address hypothermia.
Room temperature subcutaneous fluids may help address hyperthermia.
If working in an extremely hot environment with minimal to no ventilation, employ methods to keep body temperatures
within acceptable parameters. Use fans, cool floors, IV fluids, cool water bottles.
Emergency Preparation
Sterilizations in any setting, but especially in a field setting, can be complicated. Every clinic should be prepared to address
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emergencies or complications that may arise. Emergency drugs and procedures should be established and discussed prior
to the start of the clinic. Additional items to have on hand include:
Endotracheal tubes and laryngoscope. A recognized veterinary professional and the equipment and technical skill must be
available to insert an endotracheal tube in an emergency situation.
Ambu bag is essential for assisted breathing if no oxygen is available.
Often available free from human hospitals.
Emergency drugs such as atropine, epinephrine and any reversal agents. Diphenhydramine and dexamethasone should be
on hand in case of acute anaphylactic reactions.
Intravenous catheters
Intravenous fluids
The ability to address thermoregulation
Additional anaesthetics and pain medications
A chart of emergency drug doses by weight so as to minimize time performing calculations
Surgical Risk Patients

Cases presented in field surgeries are often more of a surgical risk. The desire to address as many animals as possible is
certainly a goal but should not come at the expense of individual cases. Patients deemed to be high risk should be discussed with the
owner prior to the procedure and also need final approval from the veterinarian of record prior to admission. These include
paediatric, pregnant, physically or metabolically compromised, or geriatric patients. Sometimes it is in the best interest of the animal
to not perform a surgery.
Minimum Surgeon Knowledge Base

Knowledge of the common anaesthetics and analgesics and their antidotes
Knowledge of surgical procedure to be performed
Identify and understand the use of surgical instruments and materials
Ability to tie secure ligatures (square, surgeon’s knots)
Anatomy of the surgical procedure. Allows identification of normal versus abnormal anatomy and how to surgically
address differences.
Peri-surgical skills
Recognize contamination and how to respond
Know how to isolate structures to find the source of haemorrhage and apply
Recognize complications and know how to respond
Recognize the haemorrhage, primary due to surgical complications, secondary due to disease and/or parasites.
Conclusions
Lack of adherence to minimal standards can adversely affect the patient’s outcome. While undertaking surgery every step
including decision to undertake surgery, preparation for surgery, induction and maintenance of anaesthesia, surgical procedure, and
recovery and post-operative rehabilitation is important. It is often a difficult, time consuming and sometimes frustrating process.
Proper planning can certainly help address all of the above.
3
Asepsis and Sterilization
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Hakim Athar and B.A. Moulvi
Principles of Surgical Asepsis

Sterilization is the complete destruction of micro-organisms (bacteria, viruses and spores) on items like surgical instruments,
implants, drapes, catheters, needles and attire that come in contact with tissue or enter the vascular system.
Disinfection is the destruction of most pathogenic micro-organisms on inanimate (non-living) objects, whereas antisepsis is the
destruction of most pathogenic microorganisms on animate (living) objects.
Antiseptics are used to kill micro-organisms during patient skin preparation and surgical scrubbing, however, the skin is not
sterilized. Cleaning is the removal of foreign materials (e.g. soil, organic material, micro-organisms) from objects and surfaces and
is normally accomplished by the use of water, mechanical action and detergents. It may be manual or mechanical, using ultrasonic
cleaners or washer/ disinfectors that may facilitate cleaning and decontamination of some items and reduce the need for handling.
Thorough cleaning is essential before high-level disinfection and sterilization because inorganic and organic materials that remain on
the surfaces of instruments interfere with the effectiveness of these processes. Although cleaning does remove soil and bacteria, it
does not kill or inactivate viruses. Decontamination is a process which removes or destroys micro-organisms to render an object safe
for use
Aseptic technique is defined as the method and practice that prevent cross contamination during surgery. It involves proper
preparation of the facilities and environment, surgical site, surgical team, surgical equipments and instruments. Infection first requires
micro-organisms being introduced into the surgical wound. The source of the micro-organisms may be exogenous (i.e., the air,
surgical instruments, surgical team or patient) or endogenous (i.e., organisms that originate in the patient’s body). It is impossible to
eliminate all micro-organisms from the surgical wound and sterile the surgical field, however, aseptic technique limits the patient’s
exposure to a number of micro-organisms that are detrimental.
Prevention of Surgical Infections

Prevention of surgical site infection requires attention to numerous factors. They include:
Preparation of Patient for Surgery

Before surgery, the patient should be examined for evidence of bacterial infection, including evaluation of the skin and urinary
tract, and surgery is postponed pending resolution of infection if possible. The patient’s skin is cleaned preoperatively to reduce
surgical site contamination. As skin can not be sterilized, it is usually the weakest link in the maintenance of sterile surgical field.
Preparation of the surgical site should include hair removal and cleansing to remove gross contamination, dirt and oil, and to reduce
resident skin flora prior to antiseptic skin preparation. Shaving of hair is avoided because it causes multiple lacerations and skin
erosions that are rapidly colonized by bacteria. Clipping is done immediately before the surgery and not a day before.
Surgical scrubs are applied to the area starting at the expected surgical incision and moving outward in expanding concentric
circles, moving towards the periphery. This manoeuvre is repeated, alternating rinse solutions with the antiseptic until the sponges
are free of visible soiling. Overzealous scrubbing should be avoided as it brings bacteria from within the hair follicles to the surface
and causes irritation and abrasions that are rapidly invaded by bacteria. Then a final application of the disinfectant is done and left in
place. Commonly used preparations are tinctures of chlorhexidene and iodine.
Surgical drapes should prevent the movement of debris and bacteria from non-sterile areas onto the surgical field for the
duration of surgery. They should be economical, easy to sterilize and should retain their barrier properties if they are washed,
sterilized and reused. Cotton muslin drapes are routinely used in veterinary practice. However, they lose their effectiveness once
they become wet and can allow passage of bacteria through them (strikethrough).
Preparation of the Surgical Team
The operating team consists of the people administering anaesthesia, performing surgery, non-scrubbed assistant and observers
within the operating room. All of them contribute to the operating room contamination and potential infection of the wound. Careful
preparation of the surgical team and non-sterile personnel reduces the number of bacteria in the surgical suite. A correlation has
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been noted between the number of people, their movements, and the number of airborne bacteria in a surgical suite. Therefore,
scrub suits, caps, masks, sweat bands, shoe covers, gowns and gloves are worn to prevent shed particulates and microorganisms
from reaching the surgery site.
The objective of a surgical hand scrub is to remove gross dirt and oil, and decrease bacterial counts, and to have a prolonged
depressant effect on transient and resident microflora of the hands and forearms. It should not be time consuming and should not
irritate the skin.
Surgical scrub protocols are based either on scrubbing time or on stroke counting. Fingernails are kept short, clean and free of
polish and artificial nails. Jewellery should be removed. All surfaces of the hands and forearms below the elbow are exposed to
antiseptic scrub. Special attention is paid to the area under the nails. The ideal scrub time is unknown, but 2 to 5 minutes seems to be
safe and effective, depending on the agent used.
Gloves are worn by the operating team to protect the patient from the microorganisms on the operating team’s skin. They also
protect the operating team from the patient’s micro-organisms.
Preparation of the Operating Facilities

There should be separate induction, preparation and recovery rooms. The operating room should provide an environment as
free as possible from bacterial contamination. Floors and walls should be surfaced so that cleaning is efficient, and drains should be
placed so that water does not pool anywhere in the surgical suite after cleaning. All the surfaces in the operating room should be
carefully disinfected daily, and the tables are disinfected in between operations. Operating room doors should remain closed during
the surgery, and traffic through the room should remain minimal. Air within the operating room should be under mild positive
pressure, so that when the doors open, air flows out of the room rather than into it.
Common Antiseptic Agents

Alcohols
Alcohols kill bacteria by coagulation of proteins. Ethanol is generally used as a 70 per cent solution and isopropyl alcohol is
effective in concentration of up to 99 per cent. Alcohols are effective only against vegetative bacteria, and have poor activity against
viruses and spores. When alcohol is allowed to stand in open containers, alcohol decreases in concentration and at lower
concentration, they become bacteriostatic rather than bactericidal. Alcohols are inactivated by a variety of organic debris and have
no residual activity after evaporation. Alcohols have higher and more rapid kill rate than chlorhexidine, and third best is povidone-
iodine.
Chlorhexidine
Chlorhexidine binds to protein of the stratum corneum, forming a persistent residue that can kill bacteria emerging from
sebaceous glands, sweat glands and hair follicles during surgery. It is non-irritant to the skin and its effectiveness increases after
repeated use. It is available in detergent, tincture and aqueous form. It is effective against gram positive and gram negative
organisms. Chlorhexidine (0.02 per cent), like 1 per cent povidone-iodine, promotes intra-abdominal adhesion formation and therefore
should not be used for peritoneal lavage.
Iodine Compounds
Inorganic or elemental iodine has a very broad antimicrobial spectrum compared with other agents and a very short kill time at
low concentrations, and organisms do not develop resistance to it. Its undesirable characteristics are odour, tissue irritation, staining,
radiopacity and corrosiveness. Concentration greater than 3.5 per cent is toxic to tissues and does not provide additional disinfectant
activity. Iodophors are complexes of elemental iodine with a carrier, such as polyvinylpyrrolidone (PVP), which forms povidone-
iodine. Before application of iodophor compounds, hair should be removed and the skin well cleaned to remove organic debris that
can reduce the bactericidal activity of the iodophor.
Phenols
Phenol or carbolic acid is the oldest known germicidal agent. Hexachlorophene has a relatively slow onset of action but a
prolonged residual activity, and it is not adversely affected by organic materials. Phenols are bactericidal but do not affect viruses
and spores. Hexachlorophene based preparations are inactivated by alcohol. Use was largely curtailed after hexachlorophene was
shown to be neurotoxic at levels obtained with dermal exposure.
Quaternary Ammonium Compounds

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Quaternary ammonium compounds, such as benzalkonium chloride, are cationic surfactants that dissolve lipids in bacterial cell
walls and membranes. They are effective against both gram positive and gram negative bacteria. Disadvantages are ineffectiveness
against viruses, spores and fungi, formation of residue layers, and inactivation by common organic debris and soaps.
Sterilization of Surgical Equipment/Instruments

Any equipment or supplies that come in contact with body tissues or blood must be sterile. The methods of the sterilization can
be broadly divided into two groups, physical and chemical. Dry heat, moist heat (boiling and steam treatment), filtration, ionizing
radiation (gamma and electron beam radiation) and plasmas are commonly used physical methods. Chemical sterilization is
accomplished with ethylene oxide, hydrogen peroxide, formaldehyde, ozone gases or b-propiolactone.
Commonly used sterilization processes have a variety of advantages and disadvantages. For example, the steam autoclave, a
200-year-old sterilization technology, is an effective sterilization process, but its high temperature and moisture make it unusable for
many of today’s devices. Likewise, dry-heat sterilization has process temperatures that cannot be tolerated by most devices.
Low-temperature, low-moisture processes, such as sterilization by ETO gas or hydrogen peroxide gas plasma, are used for
many medical devices. Increasingly, operating room (OR) personnel are being asked to sterilize equipment more quickly and
efficiently and with lower cost. Advanced sterilization systems that enable more rapid availability of wrapped, sterile devices and
instruments may result in more rapid turnover of the OR suite and less “downtime” between procedures. Swift and efficient
sterilization of expensive heat-and moisture-sensitive medical and surgical devices (i.e., cameras, fiberoptic cables and rigid
endoscopes) is particularly advantageous when costs of such equipment may limit their duplication in most veterinary practices. A
low-temperature hydrogen peroxide gas plasma sterilization system that provides terminal sterilization of sophisticated instruments in
55 minutes is useful for such devices.
Physical Methods
Thermal Energy
Steam sterilization is nontoxic, inexpensive, rapidly microbicidal, sporicidal, and rapidly heats and penetrates fabrics. The
temperature range within which micro-organisms survive is largely determined by the thermal viability of their proteins and nucleic
acids. Dry heat kills micro-organisms by reacting with and oxidizing their proteins, while in moist heat the microbial proteins undergo
denaturation, a process in which the three-dimensional form of the protein reverts to a two-dimensional form, and the protein breaks
down. Moist heat in the form of pressurized steam is regarded as the practical and dependable method for the destruction of all
forms of life, including bacterial spores. The denaturation or destruction of the cellular protein is the principal means by which heat
destroys micro-organisms. A critical relationship between temperature, pressure and exposure time required to kill the microbes is
the function of their individual heat sensitivities, which vary with the type of organism and the environment to which they are
accustomed. For example, bacterial spores are more resistant than the vegetative form of the bacteria. In a closed container like
autoclave, where the volume remains same, increase in pressure raises the temperature as well. If items are exposed long enough to
steam at a specified temperature and pressure, they become sterile.
Two types of autoclave indicator includes chemical indicators system, which undergoes a colour change on exposure to
sterilizing temperatures, and biological indicators, such as heat-resistant bacterial spores (e.g. , Bacillus stearothermophilus).
Spores of thermophilic aerobes and anaerobes are the most resistant forms of life to moist heat known. Virus particles are much less
tolerant to steam sterilization than are spores.
Recognized minimum exposure periods for sterilization of wrapped healthcare supplies are 30 minutes at 121º C (250º F) in a
gravity displacement sterilizer or 4 minutes at 132º C (270º F) in a prevacuum sterilizer. Steam gives up its heat to materials to be
sterilized by the process of condensation, and it is able to penetrate porous substances more rapidly than dry heat.
Sterilization failure may occur if packs are wrapped too tightly or are improperly loaded in the autoclave or gas sterilizer
container. Instrument packs should be positioned vertically (i.e., on edge) and longitudinally in an autoclave. Heavy packs should be
placed at the periphery, where steam enters the chamber. A small amount of air space is allowed between the packs to facilitate the
flow of steam (1 to 2 inches between the packs and away from the surrounding walls). Linen packs are loaded so that the fabric
layers are oriented vertically (i.e., on edge). These packs are not stacked because the increased thickness reduces penetration of
the steam. Close supervision and exact standards for preparing, packaging and loading of instruments are necessary for effective
steam and gas sterilization. Sterilization indicators should be used.
Filtration
Sterilization by filtration is used for air supply to surgery rooms (laminar flow ventilation), in industrial preparation of
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medications, and for small volumes of solutions in practice settings. For the sterilization of serum, antibiotic solutions, carbohydrate
solutions and media that are heat labile, filtration is used in which microbes are removed from liquids by means of filters with very
small pores that trap bacteria. In order to remove bacteria, the membrane pore size must be smaller than the bacteria and uniform
throughout.
Chemical (Gas) Sterilization

Ethylene Oxide (ETO)
ETO is a flammable, explosive, gas that kills micro-organisms by altering their deoxyribonucleic acid (DNA) through alkylation
and it is effective against vegetative bacteria, fungi, viruses and spores. It is the most commonly used agent in chemical sterilization.
Because it is a gas, it rapidly penetrates packaging and items to be sterilized at temperatures tolerated by almost all materials.
However, its use is limited by the size of the equipment, the time requirement, and concerns about toxicity. It is recommended for
equipment that cannot withstand the extreme temperature and pressures of steam sterilization (i.e., endoscopes, cameras, plastics,
and power cables).
Sterilization by ethylene oxide is influenced by gas concentration (450-1200 mg/l), temperature 120°-140°F (49°-60°C), humidity
(20–80 per cent) (water molecules carry ETO to reactive sites), and exposure time (1-6 hours). The time required for sterilization
depends on the concentration of ETO, humidity level, temperature, density and type of materials to be sterilized. However, the main
disadvantages associated with ETO are lengthy cycle time, the cost and its potential hazards to the patient and hospital personnel.
After sterilization by ETO, materials must be aerated to allow dissipation of the absorbed chemical, because residual ethylene
oxide can damage tissues. ETO is absorbed by many materials. The specific aeration time necessary for surgical items depends on
many variables, including the composition and size of the item, its preparation and packaging, the type of ETO sterilizer used, and the
type of aerator. The manufacturer’s guidelines should be followed, but generally aeration in a well-ventilated area for a minimum of
7 days, or 12-18 hours in an aerator, is sufficient. Items should be clean and dry before ETO sterilization, moisture and organic
material bond with ETO and leave a toxic residue. Exposure to ethylene oxide can cause skin and mucous membrane irritation,
nausea, vomiting, headache, cognitive impairment, sensory loss, reproductive failure and increased incidence of chromosomal
abnormalities. The Environmental Protection Agency (EPA) has classified ETO as a Group B1, probable human carcinogen.
Plasma Sterilization
Plasma sterilization is a low-temperature sterilization technique that has become the method of choice for sterilizing heat-
sensitive items. Conventional sterilization techniques (e.g., autoclaves, ovens, chemicals like ETO) rely on irreversible metabolic
inactivation or on breakdown of vital structural components of the micro-organism. Plasma sterilization operates differently because
it uses ultraviolet (UV) photons and radicals. An advantage of the plasma method is the possibility of sterilizing at relatively low
temperatures (50°C), preserving the integrity of polymer-based instruments, which cannot be subjected to sterilization by autoclaves
or ovens. Furthermore, plasma sterilization is safe, both for the operator and the patient, in contrast to ETO. Vapour phase hydrogen
peroxide sterilization is a form of plasma sterilization that uses hydrogen peroxide to process instruments quickly and efficiently.
Instruments can be sterilized at low temperatures (i.e., below 122° F [50°C]) and short time intervals (i.e., 45 minutes), and
they are immediately available because aeration is not required.
Gas plasma is suitable for heat- and moisture-sensitive instruments (rigid endoscopy lenses and instrument sets, objective lenses
for microscopes, nonfabric tourniquets, medication vials, aluminum, brass, silicone, teflon, latex, ethyl vinyl acetate, polycarbonate,
polyethylene (high density and low density), polyolefin, polyurethane, polypropylene, polyvinyl chloride (PVC), and polymethyl-
methacrylate, insulated electrosurgery and cautery instruments, and metal instruments). The sharpness of the delicate microsurgical
instruments remains unchanged.
Gas plasma is unsuitable for flexible endoscopes, some plastics, liquids, and items derived from plant fibers (paper products,
linens, gauze sponges, wood products including paper, Q-tip applicators, cast padding, gloves and single-use items), because these
materials absorb hydrogen peroxide and inhibit sterilization. Items that cannot be disassembled or completely dried, items with copper
or silver solder or that use bisphenole epoxy, very long narrow lumens, lumens closed at one end, folded plastic bags, and sheeting
are unsuitable for sterilization by gas plasma. An important shortcoming of plasma sterilization is its dependence on the actual
“thickness” of the micro-organisms to be inactivated because UV photons need to reach the DNA. Any material covering the
micro-organisms (e.g., packaging) will slow down the process.
Ionizing Radiation
Sterilization by radiation is used in the industrial preparation of surgical materials that are sensitive to heat or chemical agents.
Items commonly sterilized with ionizing radiation include suture materials, sponges, disposable items (i.e., gowns, drapes and table
covers), powders and petroleum goods. Re-sterilization by other means may not be possible for pre-packaged sterilized items that
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have been opened but not used because an alternate technique could damage the item and create a health hazard.
Cold Chemical Sterilization

Chemicals used for sterilization must be noncorrosive to the items being sterilized. Glutaraldehyde is a saturated dialdehyde that
has gained wide acceptance as a high-level disinfectant and chemical sterilant. The biocidal activity of glutaraldehyde results from its
alkylation of sulfhydryl, hydroxyl, carboxyl and amino groups of micro-organisms, which alters RNA, DNA and protein synthesis.
Aqueous solutions of glutaraldehyde are acidic and generally in this state are not sporicidal. Only when the solution is “activated”
(made alkaline) by use of alkalinating agents to pH 7.5–8.5 does the solution become sporicidal. It is noncorrosive to metals, rubbers
and plastics, and provides a means of sterilizing delicate lensed instruments (i.e., endoscopes, cystoscopes and bronchoscopes).
Most equipment that are safe for immersion in water are safe for immersion in 2 per cent glutaraldehyde. For the high level
disinfection of endoscopes, a 2 per cent glutaraldehyde solution without surfactant is recommended. Items for sterilization should be
clean and dry; organic matter (e.g., blood, saliva) may prevent penetration of crevices or joints. Residual water causes chemical
dilution. Complex instruments should be disassembled before immersion. After the appropriate immersion period, instruments should
be rinsed thoroughly with sterile water and dried with sterile towels to prevent damaging the patients’ tissues.
The major problems associated with glutaraldehyde are skin irritation or dermatitis, mucous membrane irritation (eye, nose,
mouth), or pulmonary symptoms, epistaxis, allergic contact dermatitis, asthma and rhinitis in healthcare workers exposed to
glutaraldehyde. Failure to rinse disinfected equipment thoroughly, leaving residual glutaraldehyde on the endoscope, has led to serious
conditions, including chemical colitis, pancreatitis and mucosal damage in human patients.
4
Sutures and Suturing Techniques
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M.M.S. Zama
Suture, a Latin word ‘Sutura’ means ‘seam’, a line formed by sewing together 2 pieces of any matter. In other words, it is the
surgical uniting of 2 surfaces by means of stitches. However, it is also referred to a material/surgical thread that is used to ligate off
the vessels or any hollow organ or keeping the organs or tissues in place. There is another term ‘Suturing’ which is the temporary
anatomical reconstruction (reduction, alignment and fixation) of severed ends of soft tissue by appropriate suture material. Surgical
thread that is used to tie off the blood vessels or any hollow structure is ligature.
Ambriose Pare (1556) first applied suturing thread on blood vessels and Joseph Lister (1876) invented the chromatization of
catgut to delay its absorption. Currently, a number of suture materials are available and selection of appropriate suture material is
determined by its characteristics (physical and biological properties), knowledge of local conditions and healing rate of the wound,
rather than on training, experience and preference of the surgeon. None of the currently available suture materials possess all the
ideal characteristics, however, many have excellent characteristics.
Properties of an Ideal Suture

Possess tensile strength corresponding to the wound where it is applied
Easy to handle with good knot security
Non-electrolytic, non-capillary, non-allergenic and non-carcinogenic
Stimulate minimal tissue reaction
Does not predispose to oedematous inflammation
Bio-inert and passes through the tissues without any friction
Inexpensive, easily available and easy to sterilize without alteration
Classification
Sutures are generally classified as absorbable or non-absorbable sutures based on their rate of degradation and loss of tensile
strength. Suture materials that retain tensile strength for longer than 60 days are classified as non-absorbable while those materials
which lose their tensile strength within that period are classified as absorbable. Further, sutures may also be classified based on the
source (natural or synthetic) or on thickness (thickest: 6 and superfine: 15-0).
Natural Absorbable Suture Materials

Catgut (Surgical Gut/Surgigut)
Catgut is prepared either from the submucosa of sheep small intestine or serosal layer of cattle small intestine and is essentially
composed of formaldehyde treated collagen. It is a capillary multifilament and is ground precisely in order to achieve a monofilament
character. Being collagenous in nature, it stimulates a significant foreign body reaction at the site of implantation. Surgical gut is
available in plain and chromic forms. Treatment with chromic salts increases its tensile strength and resistance to digestion, and also
decreases tissue reactivity. Depending on the site of implantation, its rate of absorption and loss of tensile strength varies. Premature
absorption occurs in infected environments, gastric secretions and highly vascularized tissues. Surgical catgut absorption occurs by
two fold mechanism, primarily by macrophages. First, acid hydrolytic and collagenolytic activity cleave molecular bonds followed by
digestion and absorption through proteolytic enzymes. It can be sterilized by ionizing radiation or by ethylene oxide. Sterilization by
ethylene oxide prolongs its absorption time.
Catgut generally exhibits good handling characteristics but poor knot security, when wet. Its disadvantages are intense
inflammatory reaction, variability in loss of tensile strength, its capillarity and occasional sensitivity reaction, especially in cats.
Collagen
Collagen, a multifilament suture material is obtained by processing of bovine flexor tendon with formaldehyde or chromic salts
or both. Its advantages over catgut are its non-septic source and simplicity in processing. Its rate and method of absorption resemble
to those of catgut. These sutures are almost exclusively used for ophthalmic surgery.
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Kangaroo Tendon
It is obtained from tail of Kangaroo and has very high tensile strength. It is used at high tension sites and where suture is
required for very long time e.g., bovine capsule suturing.
Fascia Lata
It is obtained from bovine fascia lata and is used for additional support to the fascial layers.
Synthetic Absorbable Suture Materials

Polyglycolic Acid (Dexon)
Polyglycolic acid (PGA) is a braided multifilament, glycolic acid polymer, which gets absorbed by hydrolysis (esterases) and not
by phagocytosis. Alkaline conditions hasten its hydrolysis hence its use is not recommended in the urinary bladder. It has superior
tensile strength compared to surgical gut, but it loses its strength more rapidly. In acute stages of infection, there is marked reaction
against the PGA than at later stages. It tends to drag through the tissues, cuts friable tissues and has relatively poor knot security.
Polyglactin 910 (Vicryl)

It is the braided multifilament, synthetic absorbable suture material and is composed of glycolic acid and lactic acids in the ratio
of 9:1. Compared to PGA, it is more hydrophobic and resistant to hydrolysis. Its absorption occurs by same mechanism as that of
PGA and also has similar pattern of loss of tensile strength as that of PGA. Polyglactin has an excellent size-to-strength ratio, is
relatively easy to handle, stable in contaminated wounds and elicits minimal tissue reaction.
Polydiaxanone
It is a monofilament suture material composed of polymer of paradiaxanone and is more flexible than PGA and polyglactin 910.
It incites little tissue reaction. Polydiaxanone is absorbed by hydrolysis similar to that of PGA/polyglactin.
Non-absorbable Suture Materials

Silk
It is obtained from the silk worm cocoons and is available as braided multifilament. Capillary action can be reduced by treating
it with oil, wax or silicone. It is readily available, inexpensive and easy to sterilize. Silk has excellent handling characteristics;
however, weaker in terms of strength and knot security. Other disadvantages of silk include tissue reactions, potential to produce
ulcerations if protrudes into the lumen, and act as nidus for calculi formation in the lumen of urinary bladder or gall bladder. Its use
should also be avoided in infected wounds as the interstices between its fibers allow serum and blood to penetrate leading to
bacterial growth.
Cotton
It is readily available and inexpensive multifilament suture material that can be autoclaved. In contrast to silk its tensile strength
and knot security increases in vivo. Its disadvantages include capillarity, tissue reactivity, inferior handling ability (electrostatic
property) and ability to potentiate infection.
Nylon
It is available as both monofilament as well as multifilament suture material. It is biologically inert and produces minimal tissue
reaction. It has an intermediate tensile strength. It can be used in infected tissues as reaction to nylon in such tissues is very less. It
is not recommended to use nylon in serous or synovial cavities as sharp ends may incite tissue reaction. The main disadvantage of
nylon includes poor handling characteristics and knot security. It is generally being called to possess ‘Memory’ which is the tendency
to revert back to the original configuration. To prevent that it is generally being applied by ‘surgeons reinforced knot or nylon knot’.
Polypropylene
It is a polymer of propylene and is available as monofilament suture. It possesses relatively low tensile strength but high knot
security, and is ductile and tough. Its knot security is superior to all other monofilament nonmetallic suture materials. It retains its
strength on implantation in tissue as it is not weakened by tissue enzymes. It is the least thrombogenic suture material available and
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is frequently used in vascular surgeries. Due to its high flexibility it is used for closing tissues with great elongation capability (cardiac
muscle and skin). Its disadvantage is slippery handling and tying characteristics.
Stainless Steel
It is the only metallic suture that is currently being used. It is available as monofilament or twisted multifilament, and is
biologically inert, non-capillary (monofilament), and can be sterilized by autoclaving. Stainless steel possesses highest knot security of
all the suture materials available with no inflammatory reaction. Monofilament form does not support infection and can be used in
infected wounds. Its disadvantages include tendency to cut through the tissues, poor handling characteristics and tendency to break
on repeated bending.
Suture Techniques
Significance of Suture Patterns
Impact on the apposition of tissues
Plays a large role in wound healing
Specific patterns can be used to accurately appose tissues, distribute wound tension, invert suture lines, and approximate
the ends of tendons
There are number of suture patterns that have been described for animal use and have been categorized into different groups
according to the following factors:
Tendency to overcome tension- like tension sutures
Anatomical area of application- like skin sutures, tendon sutures, etc
Fashion in which applied like- interrupted or continuous
Ability to promote apposition, inversion or eversion of the tissue margins
Some of the important suture patterns which are commonly used at field level are given below:
Name of Pattern Wound Edge Consideration Possible Indications

Simple interrupted Apposition Interrupted Skin, subcutaneous tissue, fascia, nerve, blood
vessels
Intradermal/subcuticular Apposition Interrupted/ Subcutaneous tissue
continuous
Cruciate/crossMattress Apposition Interrupted Skin, stump of tail, digits
Horizontal mattress Apposition/everted interrupted Skin, subcutaneous tissue
Vertical mattress Apposition/eversion Interrupted Skin, subcutaneous tissue, fascia
Far-near-near-far Apposition Interrupted Skin, subcutaneous tissue, fascia
Far-far-near-near Apposition Interrupted Skin, subcutaneous tissue, fascia
Overlapping/Vest overpant Overlapping Sustain maximum Ventral or abdominal hernias
tension
Simple continuous Apposition Continuous Subcutaneous tissue, fascia, muscles, blood
vessels
Running suture Apposition Continuous Peritoneum, thin muscle layer, loose
connective tissue
Lock stitch/ford Apposition Continuous Diaphragm, interlocking muscle layers
Lambert Inversion Interrupted/ Hollow organs like stomach, uterus, urinary
continuous bladder
Halstead Inversion Interrupted Hollow organs like stomach, uterus, urinary
bladder
Jobert Inversion Interrupted/ Hollow organs like stomach, uterus, urinary
continuous bladder
Cushing Inversion Interrupted/ Hollow organs like stomach, uterus, urinary
continuous bladder
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Connell Inversion Interrupted/ Hollow organs like stomach, uterus, urinary

continuous bladder
Locking loop/ Modified Apposition Interrupted Tendon
Kessler
Intraneural Apposition Interrupted Nerves
Tissue Consideration Suture Pattern Material Size

1. Skin No capillary action, Simple interrupted, Monofilament nylon, silk, stainless 1-0 to 3-0
allows drainage horizontal mattress steel (S.A) 1 to 2
(L.A)
2. Absorbable suture Subcuticular, simple PGA, polyglactin, polydiaxanone, 1-0 to 3-0
Subcutaneous material interrupted, lock stitch, catgut, collagen (S.A) 1 to 2-0
tissue/fascia vertical mattress (L.A)
3. Peritoneum, Least tissue reaction, Running or simple PGA, polyglactin, catgut 2-0 to 3-0
Pleura absorbable, air and continous (S.A) 1-0 to 1
water tight (L.A)
4. Hollow No capillary action, Inverted sutures PGA, poly-glactin, catgut, 3-0 to 4-0
organs (Except water tight and polydiaxanone (S.A) 1-0 to 1
urinary tract) absorbable (L.A)
5. Urinary tract Absorbable and water Inverted or lock stitch Catgut, PGA, polyglactin, 3-0 to 4-0
tight polydiaxanone (S.A) 2-0 to
1-0 (L.A)
6. Blood Least thrombo-genic, Simple continuous or For suturing (polypropylene, 4-0 to 7-0
vessels water tight and least simple interrupted nylon, silk) and for ligation (PGA, (S.A) 4-0 to
tissue reaction plain catgut, silk) 2-0 (L.A)
7. Nerves Least tissue Simple reaction Nylon, polypropylene 4-0 to 7-0
8. Tendon or Bear tension and have Bunnel Mayer, vertical Stainless steel, nylon, poly- 3-0 to 0 (S.A)
ligament strength mattress, 2-3 (L.A)
SA: Small Animals and LA: Large Animals.
Figure 4.1: Simple Interrupted Suture

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Figure 4.2: Simple Continuous Suture
Figure 4.3: Running Suture
Figure 4.4: Subcutaneous Suture

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Figure 4.5: Sub-cuticular Suture
Figure 4.6: Cruciate Suture
Figure 4.7: Horizontal Mattress Suture

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Figure 4.8: Vertical Mattress Suture
Figure 4.9: Connel Suture
Figure 4.10: Cushing Suture

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Figure 4.11: Lambert Suture
Figure 4.12: Jobert Suture
Figure 4.13: Gambee Suture

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Figure 4.14: Far-Far-Near-Near Suture
Figure 4.15: Far-Near-Near-Far Suture
Figure 4.16: Far-Near-Near-Far Suture

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Figure 4.17: Bunnel Suture
Figure 4.18: Tree Loop Pulley

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Figure 4.19: Purse String Suture
Figure 4.20: Surgeon’s Knot
Figure 4.21: Intraneural Suture

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Figure 4.22(a): Square Knot
Figure 4.22(b): Granny Knot
Figure 4.22(c): Half Hitch Knot

5
Management of Wounds
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A.M. Pawde
Wound is a separation or discontinuity of skin’ mucous membrane or tissue surface caused by physical, chemical or biological
insult. Wound healing is restoration of this continuity.
Type of Wounds
Incised: caused by sharp object
Lacerated: tearing of tissue with peculiar jagged, irregular border
Penetrating: caused by long pointed objects may lead to communication with body cavities and deep seated infections
Gunshot wounds: caused by firearms, intensity depends on the velocity of bullets may lead to incised, lacerated or
contused wound
Poisoned wounds: caused by poisons or toxins
Bite wounds: caused by bites of dogs, wild animals, snakes or birds
Virulent wounds: caused by virus or bacteria, lead to formation of pustules or vesicles
Ulcerative wounds: caused by surface evacuated due to slough of necrotic debris e.g., ischemic necrosis
Erosive wounds: necrotic areas confined only to epidermis
Punctured wounds: caused by blunt or sharp objects, they are deep and invite anaerobes
Abrasions: denuded areas of skin and mucous membrane
Contusions or bruises: no discontinuity in skin but damage to muscles, tendon, bones and nerves.
General Management of Wounds

Healing is a natural and inherent biological process and body keeps this process on priority than other functions. Clinician acts
as a positive catalyst in accelerating the wound healing process in a shortest time with minimal scar and deformity and without
complication. On the basis of injury causing agent, time elapsed and the condition of the surroundings, the wounds are classified as:
(i) clean, (ii) contaminated, (iii) septic or infected, and (iv) accidental or traumatic wounds.
Clean or Aseptic (Surgical) Wounds

In spite of taking all possible aseptic measures at the surgical site (clipping hair, washing with detergent and surgical scrub
several times, finally with 1 per cent povidone iodine and the draping at the site) and surgical instruments, no open wound is
absolutely aseptic and every wound has some infection. In horses, camels, sheep, goats and calves tetanus prophylaxis is mandatory.
Wound exposure time should be minimum, tissue not allowed to be desiccated by heat, rough handling of tissue to be avoided and
haemorrhage must be kept minimum. The wound is mopped to keep it dry, blood clots removed, drain placed and skin sutures applied
using monofilament suture with a fine swaged needle. To reduce infection, suturing of highly contaminated wound must be avoided,
and antibiotic has to be administered in bacterial infection. It is, however, said that antibiotic cover for a surgical wound is a poor
substitute for a good surgical technique. Nevertheless, prophylactic (antibiotic umbrella) or therapeutic use of antibiotic systemically
is more beneficial than topical wound dressing. Use of fly repellant is inevitable in summer months. A sutured wound heals within 7-
14 days if the wound is under dressing, immobilized and the part is at rest. Sutures are to be removed after 10th post-operative day
on assessing the wound status, if healing is not complete then alternate suture/stitch can be removed. Even after complete removal
of stitches the wound needs dressing for at least 3=4 days to heal the “suture needle pricks” (suture bites). Animal has to be cared
for another 15 days; it may scratch, rub or bite the wound and increase the risk of infection and wound dehiscence.
Contaminated and Septic Wound
In a fresh wound up to 6 hours in which the tissue reaction has not yet established, antibiotic has to be started immediately,
infection sets in only if there is tissue ischemia. A contaminated wound should be properly taken care:
Identify the microbes
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Foreign materials inside the wound should be removed

Wound irrigated with normal saline solution
An antiseptic solution is poured with the help of syringe jet first with 0.1 per cent chlorinated water and 2 per cent
hydrogen peroxide
Once again wash with the chlorinated water and finally 1 per cent tamed povidone iodine is applied
Topical debridement may be achieved with 2.5 per cent NaCl or magnesium sulphate-glycerine paste
Linen (shroud and drapes) may be applied over the wound to prevent contamination
A fenestrated tube as a drain is placed to favour drainage of the exudate
Infected Wound
The wound more than 6-8 hours after injury with inflammatory reaction in tissue becomes infected. It may be treated as an
open wound. Deep penetrating wound harbour anaerobic infection. These wounds are seldom sutured, unless infection is checked.
Wound is lavaged with 0.5 per cent sodium hypochlorite in small animals and 0.5 per cent potassium permanganate solution in large
animals. Systemic (preferred) antibiotics have to be started. Drain tube may be placed to favour drainage of pus, serum or exudate
etc. The tube is removed after 5 days.
On assessing the status of wounds, dressing has to be undertaken whether antiseptic, maggoticide or escharotic. The hollow of
the wound has to be filled with cream or ointment and finally covered with sterile gauze; likewise wound dressing has has to be
changed after every 24 hours for 7-9 days. If there is an oedema or accumulation of pus, then a counter stab incision should be
given on the dependent part to facilitate drainage of the exudate.
On cessation of exudation from the wound it may be dressed on alternate days, thereafter biweekly and later on weekly once.
Luke warm flushing in chronic wounds is helpful. Foreign bodies if any have to be removed. Suturing of wound may be done with
monofilament synthetic non-absorbable material after infection is controlled.
Accidental Traumatic Wounds

Haemorrhage has to be checked to avoid shock. Shock if present has to be treated by replenishing the fluid loss and providing
warmth to the patient. Septicaemia should be prevented by administration of proper antibiotics. Tetanus toxoid must be given in
horses, camels, sheep, goats and calves. The wound should be flushed with chilled normal saline, which will help in washing away
the dirt. The principles of treatment approach in such cases might be (i) cleansing, (ii) exicision, (iii) debridement, and (iv) delayed
primary closure. A course of antibiotic must be given for at least 10 days.
Complications of Wound Healing

Haemorrhage
Wound dehiscence
Traumatic neuralgia
Traumatic fever and septicemia
Traumatic emphysema
Tetanus
Haematoma
Sinus
Fistula
Cellulitis
Exuberant granulation tissue
Topical Wound Medication

A topical preparation should be eco-friendly, earlier agents were proven destroyers of WBCs and other cellular elements.
Phenyl, disinfectant used for mopping the floor, is sometimes used by quacks to kill maggots, diesel to flush otorrhoea, deltamethrin
or malathion as maggoticide. The use of these drugs is inhuman as they may cause pain to the animal, delay healing of wounds and it
is dangerous to human health if meat and milk of such animals are consumed. Therefore, mild antiseptic solutions should be used.
Hypertonic saline (2.5 per cent NaCl) has cleansing as well as antibacterial effect but it irritates tissue and cause negative
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chemotaxis. Povidone iodine (0.1-1 per cent) has higher concentration of free iodine, which has high bactericidal activity, however,
at higher concentration (10 per cent) it inhibits WBCs migration, fibroblastic and tissue cellularity. Chlorhexidine 0.05 per cent is
more effective as sporicide, very effective in dirty wounds, especially with clostridial spores. Sodium hypochlorite 0.5 per cent
solution release chlorine and oxygen in tissues, kills bacteria and liquefies tissues. Ointment of bacitracin, neomycin and polymyxin as
well as nitrofurazone and gentamicin solution were widely used for wound care in veterinary practice. Oxoferrin (Tetrachlor
decpoxide) similar to hydrogen peroxide helps in bringing more of haemoglobin toward wound and thereby hastening wound healing,
provided it is used alone. Besides this, for large wounds, topical anabolic steroids with neomycin ointment (Clostagen, Elder Co.) is
very effective. Chemical debridement agents or escharotics like copper sulphate, silver nitrate, potassium permanganate granules
have some disadvantages like irritation, which provokes the animal for mutilation, however, use of collagenase enzyme (Salutyl;
Elder) as an ointment helps in overcoming this problem.
Honey contains 40 per cent glucose and is rich in essential amino acids and vitamins, which are useful for treatment of burns
and sores. Similarly the butter oil preparations in combination with olive oil were also used for cracked teats, but they are known to
reduce wound epithelization.
Herbal drugs like Curcuma longa, Eriolaenia quinquelocularis, Moringa pterygospermia, Adhatoda vasica, Phyllanthus
niruri, Allium sativum, Helianthus armous, Anona squamosa, Adonsonia digitala/vulgaris, Calendula officinalis, Achrynthes
asperia, Eclipta alba, Tridex procumbens etc. have been claimed to be potent accelerators of wound healing.
Biological wound dressings like potato peel, banana leaf, bovine tracheal cartilage powder, liver spleen powder and amnion
have been also used as promoters of wound healing.
Bandaging
The primary contact layers of bandage are of two types (a) adherent, and (b) non adherent. These bandages must be sterile as
they come in direct contact with wound surface.
Adherent Bandages
Dry to dry: A dry bandage is applied in lightly oozing wound; while removing or changing the dressing, normal saline is
poured to detach adhered bandage
Wet to dry: Bandage soaked in normal saline are applied and later on water soluble antibiotics are sprinkled
Wet to wet: Bandages mostly dry, hygroscopic agent is used to liquefy the thick exudate.
Non Adherent Bandages

Petrolatum impregnated squared gauze
Secondary layer
Tertiary layer
Abscess
An abscess is an abnormal cavity containing pus, which is lined by pyogenic membrane.
Types
Acute (hot) abscess: in this the inflammatory symptoms are quite active
Chronic (cold) abscess: in this the inflammatory symptoms are less active, the pus may become partly inspissated or
liquefied
Superficial abscess: it is situated superficially
Deep abscess: an abscess that is deep seated
Embolic abscess: developing from a septic embolus
Pyaemic or metastatic abscess: a number of abscess developing in different parts of the body.
Differential Diagnosis
An abscess should be differentiated from a cyst, a haematoma, a synovial distension or an abdominal hernia. A cyst develops
slowly and fluctuates uniformly. A haematoma (containing coagulated blood and stream) has a doughy consistency and may
crepitate on palpation. It is not painful and does not point like an abscess. A distended synovial sheath is recognized by its location
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and by careful palpation. An abdominal hernia can be differentiated by the presence of hernia ring. Confirmatory diagnosis can be
made by exploratory puncture, which helps to find out the nature of contents.
Treatment
Fomentation and/or application of blisters (Bin iodide of mercury) are advised to bring about early maturation of the abscess.
However, abscess situated close to a joint or peritoneum may have to be opened before fully mature, to avoid the chances of rupture
into the joint or peritoneal cavity. After preparation of the site aseptically, an opening is made at the level of pointing with the help of
BP blade No. 15. If the abscess is not pointing at the dependent portion, it is sometimes necessary to make another opening in the
dependent part to provide drainage. This is called “counter-opening”. After opening the abscess, the abscess cavity should be
irrigated with hypertonic saline, and then it is packed with the tincture iodine dipped gauze. Gauze pack is removed after 24 hr and
then the abscess cavity is irrigated with a mild antiseptic lotion. From 2nd day onwards, the abscess cavity is packed with magnesium
sulphate-glycerine paste, which greatly favours drainage and absorption of exudates. Bismuth iodine paraffin paste (BIPP) is a
conventional antiseptic dressing used. It contains bismuth subnitras (1 parts) and iodoform (2 parts) mixed in liquid paraffin to form a
paste of desired consistency.
Factor Affecting Wound Healing

Local Factors
Surgical technique
Tissue vascularity
Mechanical stress
Movement
Extent of wound surface
Haemorrhage
Foreign bodies
Oedema and dehydration
Local irradiation
Suture material and technique
Wound infection
Topical application
Systemic Factors
Age
Obesity
Vitamin deficiency
Trace elements
Age
Obesity
6
Mangement of Tumours
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S.K. Maiti
A tumour/neoplasm is caused by a purposeless multiplication of living cells. The word neoplasm means new growth. Tumours
are common in carnivores as compared to other animals. Horse and cattle are mostly affected than sheep, pigs and goats. Old
animals are affected more commonly than young ones. Cancer, according to current opinion, is a multitude of different diseases and
is no more a “one disease’. Myriads of tumour types and plethora of their patho-physiology in different species necessitates species
wise study of tumours in detail.
The etiology of tumours is not well established. Certain types of tumours are caused by viruses, chemicals, hormonal
imbalances and gene mutations etc.
Clinically tumours may be classified into two types, benign or simple tumours and malignant tumours. A benign tumour does not
recur after removal, whereas a malignant tumour does recur.
Type of Tumours
Connective Tissue Tumours
Fibroma: consists of white connective tissue fibres, usually well capsulated and easy to remove
Chondroma: composed of cartilaginous tissue
Osteoma: composed of bony tissue
Odontoma: composed of tooth tissue
Epulis: arise from bone and periosteum at the alveolar border
Myoma: made up of muscular tissue, e.g., rhabdodomyoma-affecting the tongue
Myxoma: structure resembles connective tissue and vitreous humour of the eye
Lipoma: composed of fat cells
Neuroma: made up of nerve cells and fibres
Glioma: composed of neurogenic tissue
Angioma: made up of lymphatic or blood vessels
Sarcoma: malignant tumour involving any kind of connective tissue like bone, cartilage, fibrous tissue etc.
Epithelial Tumours
Papilloma: tumour originating from the epithelium of the skin or mucous membranes appearing in the form of a wart-like
growth from the surface.
Adenoma: epithelial tumour with a gland like structure originating from glandular epithelium, eg. adenoma of salivary
gland.
Carcinoma: malignant epithelial tumour ; e.g., carcinoma of eye, mammary gland etc.
Endothelial Tumours
Mesothelioma: develops from mesothelial tissue
Perithelioma: develops from the tunica adventitia of blood vessels
Psammoma: fibrous tumour of brain tissue
Cholesteatoma: tumour of crystalline structure; e.g., cholesteatoma of brain.
Lymphoid Tissue Tumour
Lymphoma: tumour made up of lymphoid tissue
Lymphosarcoma: malignant neoplasm arising in lymphatic tissue
Teratoma: a tumour containing disorderly arranged tissues and organs, resulting from faulty embryonic differentiation and
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organisation
Dermoid cyst: a tumour composed of cutaneous tissues
Dentigerous cyst: a tumour containing tooth
Diagnosis
By their gross appearance
Benign tumour: slow in growth, not adherent to overlying skin, usually do not ulcerate, not invade or infiltrate into
surrounding tissue
Malignant tumour: grows rapidly and gives rise to secondary tumours in their vicinity and in other parts of the body, skin
is usually adherent to the tumour and may ulcerate
Histopathological examination: malignant tumour- the cells constituting the tumour are immature and are in a state of
active multiplication.
Prognosis
A benign tumour is not harmful except when it is large enough to cause mechanical pressure on the surrounding tissues/organs
and interfere with their functions. They may be successfully excised/removed. Malignant tumours in the great majority of cases are
incurable.
Treatment
Ligation: a tight ligature is applied at the base of the tumour so as to cut the blood supply. The tumour sloughs off within
10-15 days. Ligation is convenient only in the case of pedunculated tumours.
By using red-hot iron : the tumour is clamped below its base and the red-hot iron is applied distal to the clamp so as to
remove the tumour. By this method, removal is possible without much haemorrhage.
By using ecraseur: the ecraseur is useful specially for removing small pedunculated tumours situated in the pharynx,
vagina etc. The tumour is held within the chain loop and is tightened around the base of the tumour to effect removal.
Chemical caustics: chemicals like caustic potash, arsenical paste, nitric acid, acetic acid etc. may be used for removal of
small tumours. Salicylic acid ointment is very effective for warts.
Surgical excision: the tumour is carefully dissected out from the surrounding tissues under local or regional anaesthesia.
Care should be taken to remove all the tumour cells, at the same time there should not be too much damage to the
surrounding tissues. If the surrounding lymph glands are involved, they should also be removed.
Treatment for warts : larger warts may be enucleated surgically. The use of “wart vaccine” is found useful in certain
cases in bovines. A 20-25 ml of the vaccine is given subcutaneously and is repeated once or twice at weekly intervals
(vaccine preparation protocol: remove few warts, triturate them in normal saline, leave at room temperature, remove
supernatant fluid, heat to 50ºC for one hr-add 5-10 per cent phenol-formalin. The dose is 5-10 ml s.c.) Medical grade
DMSO has also been successfully used for removal of warts. Single application usually assures gradual disappearance of
warts.
Treatment for malignant tumours : treatment is useless in the case of malignant tumours because of their tendency to
recur. But temporary relief may be afforded by total excision of the tumour. Amputation of the affected part is sometime
advisable when the tumour is situated on extremities like limbs, tail and penis. Combination of surgery along with
chemotherapy/radiotherapy also can be practised.
Cryotherapy: cryogenic technique is used to freeze and cause necrosis and sloughing of tumour tissues. A cryoprobe,
which is in the form of a hollow metal rod, is used for this purpose. Liquid or gaseous nitrous oxide (–70ºC) or liquid
nitrogen (-180ºC) is circulated. To destroy tumours of the skin, mouth and pharynx, it can be utilized.
Canine Mammary Tumour (CMT)

Of all species, dog develops neoplasm twice as frequently as humans, with incidence of skin and mammary tumours being the
highest. Tumours of mammary gland are the most common tumours of female dog representing about 30-50 per cent of all tumours
and it is the second most common tumour after skin neoplasm and most common malignant tumour in dogs.
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Figure 6.1: Venereal Tumour and Mammary Tumour in Dogs

Dogs have 5 mammary glands on each side (total of 10 breasts)-cranial thoracic, caudal thoracic, cranial abdominal, caudal
abdominal and inguinal. The normal gland should be soft and pliant, especially towards the rear legs. There should be no firm lumps.
Posterior mammary glands (4th and 5th) are often involved (about 65 per cent) compared to their anterior counter parts. The reason
for this is that the posterior glands are having greater volume of breast tissue. Both benign and malignant tumours are more frequent
in posterior glands with an incidence of 32.7 per cent and 35.6 per cent in caudal abdominal and inguinal mammary gland,
respectively.
High risk breeds: Poodle, English Spaniel, English setter, Terriers and German shepherd.
Low- risk breeds: Boxer, Chihuahua, Greyhounds and Beagles.
Mammary tumours occur almost exclusively in female dogs. However, there are several reports of its occurrence in male dogs,
which are usually very aggressive and have a poor prognosis.
The incidence increases with age of animals. The median age at diagnosis is between 10 and 12 years. Occasionally, it may be
found in animals as young as 2 years. These tumours are rare in dogs that were spayed at less than 2 years of age.
The etiology of spontaneous mammary neoplasia in dog is unknown. But several studies have been conducted to unveil this
enigma. The risk reducing effect of early ovariohysterectomy, in development of mammary tumour in dog is well documented.
Development of mammary neoplasm is hormone dependent, with risk in bitches spayed before first estrus, after one estrus and after
2 or more cycles being 0.5 per cent, 8 per cent and 26 per cent, respectively. A higher risk for mammary cancer has been reported
for multifarious bitches and in animals that have had few litters compared to those which have whelped large number of litters.
Incriminating factors put forth for etiological significance of mammary tumour in dogs are sex hormonal derangement, higher growth
hormone level, use of progestins for estrus control and b-type retroviral particles and BRCA-1/2 gene mutations.
Mammary tumours present as a solid mass or as multiple swelling. When tumours first appear they look like small pieces of pea
gravel just under the skin. They are very hard and difficult to move around under the skin. They can grow rapidly in a short period of
time, doubling their size every month or so. When tumours do arise in the mammary tissue, they are usually easy to detect by gently
palpating the mammary glands. It usually occurs most frequently in the 4th and 5th mammary gland. In half of the cases, more than
one growth is observed. Multiple glands in one or both mammary chains may be affected. Cystic ducts associated with the tumour
may cause fluid secretion through the nipple. Lymphatic involvement may cause local swelling (lymph oedema) and discomfort,
especially in the hind legs. Respiratory or other organ metastases may result in systemic problems (e.g., dyspnea, anorexia, vomiting
and diarrhoea). Benign growths are often smooth, small and slow growing. Signs of malignant tumours include rapid growth,
irregular shape, firm attachment to the skin or underlying tissue, bleeding and ulceration. Occasionally tumours that have been small
for a long period of time may suddenly grow quickly and aggressively, but this is an exception and not the rule.
It is very difficult to determine the type of tumour based on physical inspection. A biopsy or tumour removed is always needed
to determine if the tumour is benign or malignant, and to identify what type it is. Tumours, which are more aggressive may
metastasize and spread to the surrounding lymph nodes or to the lungs. A chest X-ray and physical examination of the lymph nodes
will often help in confirming malignancy.
Diagnosis
History: rate of growth, reproductive history, medication history and other systemic disorders
Documentation and measurement of all mammary gland lesions
Pre-surgical haematological and biochemical profile, as for the geriatric patient
Thoracic radiography, including two lateral and one dorso-ventral view for metastasis
Cytology: abnormal teat secretions-rarely diagnostic for neoplasia may be septic mastitis, fine needle aspiration from
lesions-positive for carcinoma-consider more radical initial surgery; negative-does not rule out malignancy
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Biopsy: eliminates all gross evidence of disease.

Histopathology of tumours: benign, malignant or mixed.
Clinical Staging of Canine Mammary Carcinoma (WHO Classification)

T T1-Less than 3 cm diameter
T2-3-5 cm diameter
T3-Greater than 5 cm in diameter
Subgroups
a) Not fixed to other tissues
b) Fixed to skin
c) Fixed to underlying muscle
T4- Any size, but inflammatory carcinoma (dermal infiltration)
N N0-No nodal involvement
N1a- Ipsilateral node, nonfixed
N1b- Ipsilateral node-fixed
N2a- Bilateral nodes, nonfixed
N2b-Bilateral node-fixed
M M0- No distant metastasis
M1- Metastatic
Stage-I: T0, T1 a, b, or c, N0, M0
Stage-II: T0, T1 or T2, a b. or c, N0 or N1a, M0
Stage-III: Any T3 tumour, with any N, and M0; Status or any T with Nb and M0
Stage-IV: Any T, Any N and M1 status
where, T= Tumor; N= Node; M= Metastasis
Treatment
Surgery
Surgery stands as first choice for the treatment of canine mammary tumours. The simplest surgical procedure in the mammary
gland should be performed in the absence of metastatic disease and inflammatory carcinoma. Six categories of surgical excision of
mammary tumours had been reported.
Removal of tumour alone (lumpectomy)
Removal of gland bearing tumour (simple mastectomy)
Removal of tumour, gland intervening lymphatic and regional lymph node (en-bloc dissection)
Removal of gland and adjacent gland 1 of 2 or 4 of 5 (half chain removal)
Removal of entire chain of 5 mammary glands + regional lymph node (unilateral mastectomy)
Removal of all 10 mammary glands, the skin covering them and the four lymph nodes at the same time (radical
mastectomy).
The goal of surgery in canine mammary cancer is to remove all tumours by simplest procedure. More surgery is not better
surgery for the dog. Upon finding any mass within the breast of a dog, surgical removal is recommended unless the patient is very
old.
If a single gland is affected, then only that gland is removed
If multiple glands on one side are affected, then the entire 5 glands on that side are removed
If multiple glands have tumours on both sides then both mammary chains are removed (all 10 glands are removed)
If the lymph nodes (axillary/inguinal) are within the resection zone, then they also are removed and especially if they are
enlarged
If a growth is detected in the number 2 gland on the left side, glands 1, 2, and 3 and the axillary lymph node on that side
should be removed
If it is found in the number 4 gland on the right side, then glands 3, 4, 5, and the inguinal lymph node on that side should be
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completely removed
If the groin region is difficult to suture closed, a flap of skin from the flank may be needed to reconstruct the area
Chemotherapy
If the tumour is malignant or shows evidence of invasion into the lymphatic system or blood vessels, chemotherapy should be
recommended. The recommended dosage of different chemotherapeutic agents is as follows:
Cyclophosphamide 0.3 mg/kg, IV for 14 days and then rest for 14 days
Chlorambucil 0.2 to 0.3 mg orally daily for 2 months
5- Fluorouracil 5 mg/kg IV for 5 days then weekly
Vincristine 0.1 to 0.5 mg/kg IV daily
Doxorubicin 30 mg/sq. m IV 21 days apart up to 4-8 treatments
Tamoxifen 20-40 mg/day orally in two divided doses for 1-3 weeks
Methotrexate 0.65 mg/kg IV at weekly intervals for 2-4 weeks
Nanosomal Paclitaxel 150 mg/32 kg b.wt on days 0/21/42
Nanosomal Docetaxel 30 mg/32 kg b.wt on days 0/21/42
Prognostic Factors
If a dog is spayed before the first estrous cycle there is about 0-0.5 per cent chance that this dog will develop mammary
cancer
Spaying a dog after the 4th estrous cycle or after 2.5 yr of age will not decrease the risk for developing mammary cancer
After a dog has mammary cancer, spaying the animal does not decrease the recurrence rate of the cancer, as these
tumours are not under the influence of estrogen
The larger the mammary tumour the greater is the risk that it has spread to the lymph nodes, lungs or other parts of the
body
When a mammary tumour is found, there is 50 per cent chance that it is malignant and 50 per cent chance that it is benign
Of the malignant mammary tumours, 50 per cent have already spread at the time of diagnosis
If a dog has multiple tumours, some may be malignant and some may be benign
If the tumour is less than 3 cm in size the recurrence rate is relatively low, and if greater than 3 cm the recurrence rate is
fairly high
If the biopsy indicates that the mammary tumour has spread to the lymph nodes, lymphatic channels or blood vessels, the
prognosis is poor
If the biopsy indicates that the tumour is surrounded by lymphocytes, a better prognosis is expected.
Complications
Anesthetic death-rare
Infection-rare
Breakdown of the incision, which may require re-suturing of the wound or leaving it to heal on its own
Spread of cancer to other regions of the body (lymph nodes, lungs, bones)
Recurrence.
7
Affections of Horns
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Aswathy Gopinathan and Kiranjeet Singh
The shape, built and contour of horn is a major criteria to characterize different breeds of indigenous Zebu cattle of India. The
males with hefty horns are venerated for all ceremonies related to religion or agriculture. In sharp contrast to this, the cattle in
countries with well developed bovine industry or organized dairy sector are routinely dehorned. Dehorning is one of the oldest and
most common surgical procedures done in cattle. Dehorned cattle are safer for handlers and to other cattle. Apart from cattle
welfare, this procedure is economically significant by preventing losses due to damage to the hide, safer while transport as well as
marketing the livestock. Dehorning is an elective procedure except in cattle with fractured horns or osteomyelitis. Cosmetic
dehorning is performed in somewhat mature animals which have a defective horn, or to treat accidental horn fractures or horn
cancer.
Anatomy
The modified epithelium destined to become the future horn grows from the skin as “horn buds”. This can be very well felt as
soft buttons on either side of the poll. Under this, the cornual process of the frontal bone grows and it takes nearly 2 months for the
horn bud epithelium to attach to the developing cornual process on the frontal bone. The cornual process gets covered with the blood
bearing corium and the cornified epithelium. At the time of dehorning a skin tissue of 1-1.5 cm around the base of horn also needs to
be removed since there lies the germinal epithelium to horn. If this area is also removed, the haired skin will replace the defect
without re-growth of horn.
Blood supply to the horn: Cornual artery, which is a branch of superficial temporal artery. Nerve supply to horn-cornual
nerve a branch of zygomatic temporal nerve, which is a branch of the trigeminal nerve.
Restraint
Young animals can be straddled and held tight while the adult animals have to be restrained in a stanchion or in a chute with a
head gate, the head tightly haltered and secured to minimize movement.
Anaesthesia
Two per cent lidocaine, loaded in a syringe with 18 gauge, 1-1.5 inch needle, 3-10 ml/side is injected half way between the
lateral canthus of the orbit and base of the horn just under the shaft of frontal crest to block the cornual nerve and wait for 5-10
minutes. Aberrant innervations can often lead to lack of proper anaesthesia. Alternately, 100 mg xylazine added to 100 ml lidocaine
administered locally at the rate of 0.1 mg/kg, half the dose at the base of each horn will provide adequate sedation in fractious
animals.
Technique for Dehorning

It can be chemical, thermal or cutting.
Chemical Dehorning
A paste of sodium hydroxide, potassium hydroxide or calcium hydroxide applied at the area of buds, monitoring the animal so
that the paste do not gravitate towards the eyes.
Thermal Dehorning
It is useful in small calves, where the dehorner can be entirely fit into the base of the horn bud. Portable electric dehorners are
used on a shaven bud to make a circular cut around with adequate pressure and a twist upwards scoops the horn bud out. It must be
done long enough to see a complete white rim of bone under the base of the burned bud to ensure that the blood supply to the horn
bud is completely cut off.
In young animals that have missed the early disbudding procedure, it can be achieved through different devices like cutting
dehorner (saw/obstetrical wire) or gouging forceps.
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Cosmetic Dehorning (Amputation of Horn)

It allows primary closure of the skin after removing the horn for achieving a cosmetic appearance. It produces less scarring
than the above mentioned techniques, requires less healing time and can be performed in mature animals. Anaesthesia is achieved
by infiltrating 5-10 ml of 5 per cent lidocaine in fan shape, under the frontal ridge half way between the lateral canthus of the eye
and base of horn. All the animals require a hemi-circumferential infiltration of local anaesthetic on the caudal aspect of the horn base
to anaesthetize cutaneous branches of second cervical spinal nerve. In adult goats both corneal and infratrochlear nerves supply to
the horn. Cornual branch is blocked with 2-3 ml lidocaine half way between the lateral canthus of eye and the lateral horn base, as
close as possible to the ridge of supraorbital process. Infratrochlear branch is desensitized by 2-3 ml lidocaine infiltrated half way
between the medial canthus of eye and medial horn base, dorsal and parallel to the dorso-median aspect of the orbit. Infiltration
should be done as a line block (maximum dose is 10 mg/kg in goats since they are sesnsitive to lidocaine toxicity). Administration of
xylazine 0.05 mg/kg IV helps to sedate the animal.
Clip the hair around a wider area of horn base and pole. Elliptical incision is made leaving more than 1 cm margin around the
base of horn, leaving 5-7 cm dorsal to and 5-7 cm ventral to the base of horn. The skin is dissected sharply from the underlying
tissue in the ventral incision. An obstetrical wire is placed against the frontal bone at the ventral incision and directed towards the
pole, and saw off the horn as close to the base of the horn as possible. Proper seating of the wire at the base of the horn is required
to saw off the germinal epithelium at the horn base. Lavage the area with saline. The exposed cornual artery is ligated for
haemostasis.The bone chips are removed and the area is washed thoroughly with normal saline. Undermine the skin to appose the
wound edges. The skin edges are sutured by a series of simple interrupted sutures or mattress sutures with silk or nylon, and the
sutures are kept for 2 -3 weeks.
Complications
Continuous bleeding cautions one to reopen the skin, pull the bleeder out and ligate it. A cotton pad soaked with tincture benzoin
can be placed over the wound and kept until it is shed by its own. Any medication going into the sinus can cause severe irritation.
Infection to the sinus can be prevented by undertaking proper aseptic technique. Sinusitis is a potential complication of this
procedure; animals are produced with malodorous discharge from the site of dehorning, pyretic, anorexic and lethargic. The sinus
should be opened and lavaged thoroughly with anti-inflammatory and antibiotic therapy for 2-3 weeks.
Chronic sinusitis can lead to bone osteomyelitis and sequestrum formation. Another unusual complication is skull fracture, when
the instruments (saw) is not sharp and if undue pressure is exerted.
Horn Avulsion
This can occur due to trauma when the corium surrounding the horn core gets avulsed. The horn core is either intact or
sometimes fractured, the main challenge is to control haemorrhage. A gauze bandage soaked with tincture benzion can be applied
and let it remain there till shed off by its own. Fly repellants and anti-inflammatory drugs should be given for 1-2 weeks. If the horn
is fractured, it can be amputed by any of the above said methods.
Horn Cancer
The squamous epithelial cells lining the base of the horn core can get converted to squamous cell carcinoma, this condition is
usually seen in adult cattle 5-10 years old. The reasons can be multifactorial like trauma, radiation, chronic irritation etc. Higher
prevalence of this condition is seen in castrated bullocks. Clinical signs are continuous shaking of the head, rubbing of horn against
hard objects, slimy or bloody discharge from the nostrils or base of the horn, soft tumour mass exposing the horn from its base.
Surgical removal of the horn can be attempted. Immunotherapy with tumour cells suspended in Freund’s complete adjuvant can be
injected subcutaneously at an interval of 5 days. Intra lesional injections of BCG or BCG cell wall extracts has also been tried with
varying success rate.
8
Aural Haematoma in Dogs
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J. Mohindroo
Aural haematoma or ear haematoma is one of the most common conditions encountered in small animal practice. It is the
accumulation of blood, either fresh or clotted, within the pinna (ear flap). The ear flap is composed of a layer of skin on each side of
a layer of cartilage. The cartilage gives the ear flap its shape. Blood vessels go from one side to the other by passing through the
cartilage. The haematoma usually arises as a self-inflicted injury from scratching and head shaking. Violent shaking causes the
vessels to rupture and bleed into the space between the ear cartilage and skin. Other reasons for the dogs shaking their ears may
include bite wounds and otitis externa. Dogs with long, pendulous ears are at greater risk for developing ear haematoma. Dogs with
clotting or bleeding disorders may also develop haematomas, with or without a history of trauma. When a haematoma is present, the
pinna will appear very thick and spongy (Figure 8.1).
The swelling may involve the entire pinna or it may involve only one area. The swelling may occasionally become large and
painful, and at times may occlude the opening of the ear canal. The extra weight of the ear flap may be uncomfortable and may lead
to a permanent change in the cartiage of the ears and the affected ear may drop down permanently. Diagnosis usually can be made
on palpation and physical examination. Whenever a dog is presented with ear haematoma it is important to address the underlying
cause before initiating the treatment.
Surgical drainage is considered the most acceptable method of treating aural haematoma in dogs. The surgery is done under
general anaesthesia, which may be induced with protocols which are well described in the standard books. It is preferred to pre-
anaesthetise the animal with a combination of Butorphanol 0.2 mg/kg b.wt, Acepromazine 0.05 mg/kg b.wt and Glycopyrrolate 0.01
mg/kg b.wt mixed in a single syringe and administered intramuscularly. Anaesthesia is then induced using 5 per cent Thiopental
sodium 8-10 mg/kg b.wt i/v and maintained with 1-2 per cent Isoflurane using Boyle’s apparatus (inhalation anaesthesia machine
with partial re-breathing system. Under the field condition the dog may be anaesthetised with a combination of Xylazine 1 mg/kg,
Ketamine 5 mg/kg and Atropine sulphate 0.045 mg/kg administered intramuscularly. Endotracheal intubation should be done prior to
the start of surgery to provide a patent airway. The affected ear is kept uppermost and the ear is shaved and prepared for aseptic
surgery. The ear canal is plugged with sterile gauze prior to making incision. A linear incision is then made on the concave surface
of the ear pinna to drain the haematoma completely. An ‘S’ shaped or a diamond shaped incision may also be made to facilitate
drainage of the haematoma. After completely evacuating the haematoma, the fibrin and clots are removed, and the cavity is
freshened with a sterile gauze piece. The cavity should then be flushed with povidone iodine (betadine) before closure. Closure of
the cavity is accomplished by placing multiple through and through sutures using a non absorbable suture material (nylon) in a
horizontal mattress fashion (staple sutures) starting from the periphery to the incision line (Figure 8.2). After applying a series of
sutures, care is taken to keep the incision line gaping so as to facilitate continuous drainage of any fluids that may tend to
accumulate. The ear pinna is then bandaged after placing rolls of cotton bandage/card board/X-ray film or any other stiff material on
both sides, and then pressing the ear pinna against the dorsum of the head. This would provide sufficient pressure to prevent
recurrence of the haematoma and maintain the integrity and shape of the ear pinna. Good bandaging technique usually prevents the
complications of wrinkling/puckering and dropping of the ear pinna. The sutures are removed after 3 weeks. The cosmetic outcome
with this method is usually good (Figure 8.3). Despite being recognised as one of the best methods of treatment of ear haematoma,
surgical treatment may be associated with complications like wrinkling and puckering of the ear (Figure 8.4), drooping of the pinna
and further damage to cartilage of pinna leading to permanent deformity.
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Figure 8.1: Haematoma of the Right Ear Showing Swelling of the Ear.
Figure 8.2: Application of Multiple Horizontal Mattress Sutures Using Nylon.

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Figure 8.3: Good Cosmetic Outcome after Surgical Treatment of Haematoma.
Figure 8.4: Wrinkling of the Ear after Surgical Treatment of Haematoma.

Many other techniques (surgical and conservative) have been tried for treatment of ear haematoma viz. needle aspiration,
administration of corticosteroids and gentamicin after aspiration, iodoform wick placement after incising the haematoma, malleable
silicon lined ear dressings and placement of teat cannulas and catheters. Silicon, latex, PVC drains, carbon dioxide lasers and
recently stainless steel staples have also been used. However, all the techniques have certain limitations. Needle aspiration might
lead to re-accumulation of blood/fluid, severe crumpling and scarring of the ear. Glucocorticoids further separate auricular cartilage
and delay healing. Dressings also might not provide sufficient pressure and are considered inappropriate for large haematomas.
Cannulas and catheters cause irritation and there is potential for continuous serosanguinous discharge from the tube. Drains like
PVC and latex have been reported to cause drooping and disfiguration of ear pinna due to shrinking, fibrosis and cartilage erosion.
Stainless steel skin staples applied on the concave aspect of the haematoma (Figure 8.5) have proved to be a fast technique, which
requires less than a minute to complete the surgery. However, the cost of the staples is a limiting factor. Another limitation with the
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stainless steel staples is that it cannot be used in haematomas where the skin/cartilage is very thick.
Figure 8.5: Stainless Steel Skin Staples Applied on Medial Surface of the Ear Pinna after Complete Healing.
Cyanoacrylates have also been tried, but intense granuloma formation discouraged their use.
9
Management of Basic Eye Affections in Animals
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S.P. Tyagi
Though the management of various eye disorders in animals require a thorough specialized subject training of post-graduate
level but in India due to the lack of the concepts of veterinary ophthalmic referral centres manned by Veterinary ophthalmologists,
the field vets have to be adequately trained to deal with such cases at their own level or at least to manage initial treatment in a
proper manner. This process requires not only acquiring the necessary surgical skills but also ensuring availability of commensurate
basic diagnostic and therapeutic infrastructure. With such enabling support, most of the ocular problems of animals including
intimidating emergencies can be successfully treated at field level with a surprising ease. The present report deals with some of such
common eye problems of animals briefly:
Ocular Worms
Different kinds of slender worms can be observed in the eyes of different species of animals causing a variety of symptoms.
The most common worm infestation by ‘Thelazia spp.’ is caused by ‘face fly’ feeding on ocular secretions. The dogs are
commonly affected. The female worms residing in conjunctival sac of the infected animal discharge larvae in ocular secretions,
which are ingested up by the face fly. Theses ingested larvae become third stage larvae within few weeks and appear in the salivary
secretions of flies and deposited in host’s eye during feeding and once inside conjuntival sac, they mature within few weeks.
Figure 9.1: Thelazia callipaeda within Conjunctival Sac of a Dog.

Though majority of animals remain asymptomatic, but some show various clinical symptoms particularly when the worm load is
heavy. The signs are: epiphora, conjunctivitis, frequent rubbing of eyes, corneal opacities, thick mucoid discharge and occasionally
corneal ulcers. The infection may remain present all through the year.
Physical examination of the conjunctival sac after protracting the third eyelid usually immediately shows the presence of such
worms in the affected animal. The worms are white or creamy coloured with a length ranging from few millimetres to about 2 cms.
Occasionally some of the worms come out of conjunctival sac and may be observed slithering over the cornea and sclera. The
worms are usually multiple. The worms may be removed manually by picking up with a serrated ophthalmic forceps and flushed
with BSS. The secondary lesions of the eye generally heal spontaneously but may be appropriately treated, if needed. Systemic
ivermectin, doramectin and levamisole are effective against such worms and can be used, though facial hygiene and strict fly control
in endemic area are essential steps in proper prevention of this problem.
Occasionally another kind of eye-worm belonging to “Setaria spp.” is also observed in different species of animals. The
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equines are commonly affected. Such worms are transmitted by the mosquito bites. These worms are predominantly found in the
peritoneal cavity of the infected animal without causing much harm except occasional mild peritonitis. The larvae produced by these
worms enter in to the blood stream and ingested by mosquitoes during blood sucking. The larvae develop in the muscles of
mosquitoes and become infective within 15 days and then appear in the saliva of mosquitoes. When such mosquitoes bite another
animal, such infective larvae are transmitted. Occasionally young worm migrate to anterior chamber of the eye and cause severe
inflammatory reactions.
Figure 9.2: Setaria equina inside Autinar Chamber of Eye in a Mule.

The common clinical symptoms are epiphora and various degrees of corneal opacities. The other symptoms of uveitis will also
be present. The naked eye examination generally easily reveals presence of slender thread-like whitish worm (mostly singule)
wandering inside the anterior chamber of eye in the initial stages. However, spotting of worm is not easy when the corneal opacity
worsens later on. The movement of worm may be stimulated by light, though it results in discomfort to the animal. In cases where
worm is suspected but not visible due to complete corneal opacity, ophthalmic ultrasonography confirms the diagnosis.
The worm should be removed surgically before any anthelmintic is given because dead worm initiate sever immune mediated
inflammatory response worsening corneal opacity. The procedure should be performed preferably under general anaesthesia (GA).
The animal is secured in lateral recumbency after induction of GA. The eye is flushed with very dilute Povidone-iodine solution (5
per cent Betadine solution diluted with NS in a 1:50 ratio) and thoroughly lavaged with BSS after a few minutes. A few drops of 4
per cent Lignocaine are used to desensitize the cornea and a topical antibiotic-steroid combination (like Gatifloxacin-Prednisolone) is
instilled over the eye. Suparorbital nerve block may be accomplished, if need be. The eyelid retractor is applied or alternatively
eyeball is stabilized with three 4-0 sutures placed through Tenon’s capsule approximately at 11, 3 and 7 O’clock position. A partial
thickness clear corneal incision approximately 2 mm away from limbus is made in between 10 or 2 O’clock position of the cornea
with a 2.8 mm ophthalmic crescent knife (though less preferred BP blade No. 11 can also be used for such incision). The anterior
chamber is then entered with a stab force as soon as the worm comes near to the incision site and the knife is removed back with
the same action. Simultaneously the eye ball is pressed from opposite side. The worm generally comes out easily along with the
outflow of aqueous humour. In cases, where worm does not come out, the anterior chamber can be flushed with BSS like Ringer’s
lactate and the worm manually picked up using serrated ophthalmic forceps. If too much movement of worm causes problem in
picking it up, sterile viscoelastic substance (e.g. Inj MIOSOL-PFS) can be injected into the anterior chamber to restrict its
movement. Care must be taken not to force the worm deeper during this process, thus the canula of ‘visco’ injector should be under
the worm and near the iris during injection. The stab incision up to 2.8 mm can be left as such without suturing. Post-operatively 2
drops each of topical antibiotic-steroid combination and a cycloplegic like 1 per cent Tropicamide may be instilled in the eye q.i.d. for
a week. The topical ointments should be avoided for the first few days.
For destroying the circulating microfilariae and the adult worms at other places of body, suitable systemic anthelmintic should
be used post-operatively.
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Entropion
It is the inward rolling of the eyelid margin leading to corneo-scleral irritation because of rubbing of misdirected eyelid cilia. It
may be developmental or cicatrical in origin or may be spastic occurring secondary to pain and blepherospasms. The dogs are
commonly affected animal species.
The clinical symptoms are epiphora, rubbing of eye, mucopurulent discharge from the eye and photophobia. In chronic cases
conjunctival congestion, corneo-scleral vascularization and corneal ulcers may develop. In cases of developmental entropion, the
symptoms are not as distinct in initial stages as the cilia are softer.
Physical naked eye examination reveals the exact extent of entropion and either (commonly) a part of the eyelid margin or (less
commonly) whole of the eyelid margin is found rolled inwards with its cilia touching the cornea. The lower eyelid is commonly
affected.
The treatment consists of either eyelid tacking or surgical excision of lid tissue popularly known as ‘Hotz Celsus’ procedures.
The eyelid tacking is fit for neonates or very young patients up to 20 weeks of age. Maintaining eyelids in relatively normal
position for a few weeks may sometimes resolve the problem permanently. Repeated tacking may be undertaken until maturity
when if required, excisional procedure may be adopted. For simple eyelid tacking, the skin adjacent to entropion area is grasped with
a tissue forceps and attached with adjacent skin using tissue adhesive, thus creating a little fold which evert the eyelid margin
sufficient enough to correct the entropion.
Figure 9.3: Entropion in a Dog towards Lateral Aspects of Lower Eyelid.
Figure 9.4: Eyelid Tacking using Inverted Lamber Suture.

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Figure 9.5: Techniques for Correction of Entropion in a Dog.

The eyelid tacking can also be done by applying inverted Lambert sutures at eyelid margins using non-absorbable 3-0 to 4-0
sutures with animal under GA. For this procedure, start suture bite from approximately 3 mm away from the eyelid margin, involve
about 5 mm skin and orbicularis muscle in first bite; exit 5 mm away and take a second bite of about same 5 mm length involving
skin and orbital fascia. Tie the suture and thus inverting a furrow of skin. A drop of tissue adhesive may be used additionally to stick
the skin folds around the skin furrow.
In severe cases or in mature animals eyelid skin resection is necessary to correct entropion. The Hotz-Celsus or “pinch”
procedure is most commonly used for this purpose.
With animal under GA the eyelid margin is grasped with a forceps to estimate the wedge area to be removed for correction of
entropion. The eyelid is stabilized with an eyelid plate placed under conjunctival fornix, the eyelid is stretched and the wedge shaped
area of skin estimated as explained above is excised using BP blade No. 15. The incision should be 1-3 mm away from the eyelid
margin. The skin defect is closed by suturing the edges of skin with 4-0 non-absorbable interrupted sutures. Remember that 0.5-1.0
mm additional eversion of eyelid may occur during healing period; this fact should be taken into account while estimating the size and
excising the skin wedge.
Elizabeth collar, topical antibiotic-steroid combination and systemic NSAID are to be used post-operatively for a few days.
Ectropion
It is the eversion of the lower eyelid margin commonly seen in dogs. It may be developmental or secondary to scar tissue
formation or simply fatigue of orbicularis oculi muscle. In certain breeds like St. Bernard, the eyelids and palpebral fissure are
excessive in size which predisposes the animal for ectropion.
The clinical symptoms arise because of exposure of bulbar and palpebral conjunctiva and inability of animal to channelize its
tears in to nasolacrimal system efficiently. Thus epiphora, chronic keratitis, conjunctivitis or keratoconjunctivitis are observed in
affected animal.
The common surgical treatment is ‘V to Y eyelid plasty’. In this procedure, a V shaped piece of eyelid skin is removed just
below the ectropion area. The base of this ‘V’ is kept towards eyelid margin starting about 1 mm below it. Now beginning at the
most distal aspect of the ‘V’ incision the skin edges are closed together with simple interrupted 4-0 non-absorbable sutures; thus
making the stem of the ‘Y’. Working upwards the stem of ‘Y’ is lengthened until eyelid margin elevates to its normal position.
Usually this length is 2-3 mm more than the actual ectropion area. Once the eyelids are in normal position, the remaining tissue
defect is sutured to form arms of the ‘Y’.
The post-operative care remains same as explained in entropion correction.
Remember, entropion and ectropion may occur simultaneously in the same animal in the same eye or in the same eyelid.
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Figure 9.6: Ectropion in a Dog and V-Y Blepheroplasty for its Surgical Correction.
Cherry Eye
It is the protrusion of third eyelid gland in young dogs and cats. This results probably due to defect in the retinaculum, which
anchors the gland in the periorbital region.
The clinical symptoms arise due to exposure of third eyelid and its subsequent desiccation causing irritation to the animal. Thus
the symptoms are a visible fleshy mass towards medial canthus of eye accompanied with abnormal tear production and discharge;
occasional rubbing of eye may lead to exposed tissue damage. The condition may be unilateral but most likely turns bilateral.
Medicinal treatment with topical antibiotic-steroid combination is helpful but seldom curative without surgical intervention. The
preferred surgical option is one among many techniques to replace the gland in its normal position. The option of partial or complete
excision of gland is reserved only for refractory cases because removal of third eyelid gland will deprive the animal of an important
source of tears. This gland produces up to half of the total tear volume and thus animal will be predisposed to keratoconjunctivitis
sicca (KCS) or ‘dry eye’ following this gland’s excision. However, non-treatment of the condition for a long time will also
incapacitate this gland to form tears and rather increase the chances of developing KCS compared to even early excisional options.
The common surgical options for gland replacement are conjunctival mucosa pocket technique, intra-nictitating tacking
procedure and posterior (bulbar) nictitans anchoring techniques. Here the easier conjunctival mucosa pocket technique is described,
which is suitable for small protruded masses.
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Figure 9.7: Cherry Eye in a Napolean Mastiff.
Figure 9.8: Conjunctival Mucosa Pocket Technique for Correction of Cherry Eye.
For this procedure, the animal is anaesthetized and secured in lateral recumbency with the affected side up; its third eyelid is
grasped with thumb forceps and protracted forward to expose its bulbar surface. The third eyelid gland is identified and two curved
incisions are given on conjunctiva mucosa on either side of this gland with the help of BP blade No. 15. The edges of these incisions
are not joined. Now the central mucosal covering over gland is left undisturbed, whereas, little undermining of conjunctiva is done by
directing the Steven’s scissors away from gland to free up the incised conjunctival margins. These edges are now pulled over central
gland and closed with 5-0 to 6-0 absorbable continuous sutures with buried knotting technique.
The post-operative care remains same as described above.
Remember cherry eye condition of Napolean Mastiff breed of dogs (Picture above) is not amenable to gland replacement
procedures and thus need to be excised for treatment.
Dermoids
Ocular dermoids are characterized by island/s of skin that are histologically normal but are located at abnormal places like
cornea, sclera, nictitating membrane, eyelids etc. Such affections are observed in all animal species sporadically.
The clinical symptoms are due to irritation of eye surface with the hairs of dermoid and thus include chronic epiphora,
conjunctivitis and keratitis.
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Figure 9.9: Dermoid involving Nictitating Membrane in a Calf.
Figure 9.10: Dermoid Involving Cornea and Selena in a Calf.

The treatment is surgical excision of the complete growth. If the dermoid involves cornea, then the surgery is to be performed
by an experienced ophthalmic surgeon as it may involve technically more demanding partial keratectomy.
Foreign Bodies in the Eye

Penetrating or non-penetrating, both kinds of foreign bodies (FB) may cause severe damage to the eye in animals. Some
smaller foreign bodies may get lodged under the eyelids and continue to irritate the corneo-scleral surface for a long time. Therefore
any animal showing epiphora should be carefully examined for FBs inside both conjunctival fornix and around nictitating membrane.
Ease of removal of FBs depends upon their lodgement site. Non-penetrating FBs can be easily picked up by forceps; whereas,
FBs penetrating cornea or other internal structures should be handled very carefully. Attempts to retrieve penetrating ocular FBs
should be done only under GA. The FBs may get broken with rough manipulation and complicate further retrieval. Damage to
surrounding structures should also be minimized during such manipulations; the iris in particular is prone to haemorrhage.
Traumatic Ocular Proptosis

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It refers to forward displacement of eyeball following usually a blunt trauma, bite wounds and forceful restraint. It is common in
dogs and more common in brachycephalic breeds as they have shallow orbital cavity and large palpebral fissure.
Once it occurs, the palpebral margins are generally entrapped behind the eye and the contracture and continuous spasms of the
orbicularis muscle prevent the eyeball to relocate to its normal position spontaneously. Ocular muscle damage, venostasis, chemosis,
subconjunctival haemorrhage and corneal drying soon follow.
Figure 9.11: Severe Kerato-Conjuctivitis in a Dog.
Figure 9.12: A Piece of Wheat Straw Penetrating Cornea Iris and Lens in a Cow.
This condition is a surgical emergency and should be treated immediately to improve chances of restoration of vision and the
shape of eye. If the eyeball is not ruptured and cornea and extra-ocular area are not much damaged, the eyeball should be replaced
back surgically to its normal location. For this keep the eye moist with a BSS until the animal is anaesthetized. Lubricate the eye
thoroughly with antibiotic ointment or artificial tears. Administer large doses of intravenous corticosteroids frequently
(Methylprednisolone sodium succinate @ 30 mg/kg initially followed by 15 mg/g at 2 and 6 hours) to treat or prevent optic
neuropathy and orbital oedema. Quickly prepare the area and induce GA with a short acting anaesthetic.
Evert and retract eyelids with the help of ophthalmic muscle hooks, and apply gentle retrograde pressure on the globe with any
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flat instrument or simply with moistened cotton ball to replace it; perform lateral canthotomy if required (A &C). Flush the
conjunctival fornix with BSS and perform temporary tarsorrhaphy (D). The eyeball may still appear partially prolapsed and larger
than normal due to venocongestion and partial filling of retrobulbar space by blood. This will improve later. If canthotomy was
performed, closed it now with simple interrupted non-absorbable 4-0 sutures.
Figure 9.13: Traumatic Proptosis in a Dog and its Surgical Correction Technique.
For tarsorrhaphy, 4-0 to 5-0 non-abosorbable sutures are used in dogs. Horizontal mattress sutures are preplaced at the lid
margins to appose them later. Stents are used to distribute the tension on the suture line (B). The bite of suture needle is taken only
in the outer one third of the eyelid to avoid contact of sutures with cornea (D); the needle exits through the orifices of tarsal glands
from eyelid margins. The sutures are tightened simultaneously and the eyelids are apposed.
Post-operatively broad spectrum systemic antibiotic is administered two to three times a day for 7-10 days. Oral prednisolone
@ 1mg/kg are given for first 7 days with decreasing doses over the next 14 days. Topical antibiotic-steroid combination and
cycloplegic drug (e.g. 1 per cent Tropicamide) are given for 7-10 days. Cold compresses on the affected eye for the first 2-3 days
and warm compresses for next 2-3 days also help in improving the condition. Elizabethan collar should be applied to prevent self-
mutilation. Canthotomy sutures are to be removed after 10-14 days and tarsorrhaphy sutures after 14-28 days depending upon the
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condition.
Figure 9.14: Tumours involving Eyelid, Periocular Tissue, Selura, Nictitating Membrane and Cornea in
Animals.
Ocular Tumours
Various types of benign and malignant ocular tumours may be found in all species of animals involving different parts of the
eye. Only benign types are amenable to surgical excision. These can be excised following standard operative procedure just as any
other tumour.
Basic Ophthalmic Surgery Pack for Small Animals

Backhaus towel clamp 6 small sized
Metzenbaum scissors straight 1 small sized
Metzenbaum scissors curved 1 small sized
Halstead artery forceps 2 each curved and straight small sized
Barraquer wire eyelid speculum 1 each small, medium and large
Labermann speculum 1 small and medium size each
Steven’s tenotomy scissors (blunt tips) 1 each straight and curved
Corneoscleral scissors Castroviejo 1 right/left pair
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Iris scissors 1
Adson tissue forceps 1X2 teeth straight 1 small sized
Entropion/chalazion forceps 1
Cilia forceps 1
Bishop-Harmon tissue forceps 1X2 teeth 1
Bishop-Harmon tissue forceps serrated 1
Lid plate 1
Beaver scalpel handle 1
Blade No. 6400, 6500, 6700 Q.S.
Castroviejo needle holder 1
Tying forceps smooth edge Straight and curved
Tying forceps serrated edge Straight and curved
Microsurgery needle holder 1
Muscle hook
Silicon bulb and canula 1
Cannula 18-27 G 5 different gauge
SS cup/bowl 1
Sterilization trays with silicon pad 1 each large size and double decker type
Miscellaneous Basic Ophthalmic Items

Disposable ophthalmic cautery 1
Schiotz tonometer 1
Direct ophthalmoscope 1
Fluorescein test strips pack Q.S.
Schirmer tear test strips pack Q.S.
Absorbable synthetic (Vicryl) suture 6-0, 8-0 Q.S.
Non absorbable synthetic (Prolene/Nylon) suture 4-0, 5-0, 6-0, 8-0 Q.S.
Inj. 2 per cent Hydroxypropylmethyl cellulose (Miosol-PFS) Q.S.
Eye drops Q.S.
1 per cent Tropicamide (Triocyl)
2 per cent Pilocarpine (Pilocar)
0.03 per cent Flurbiprofen sod. (Flur)
0.3 per cent Hydroxypropylmethyl cellulose (Miosol)
Ofloxacin-Dexamethasone (Ocipred)
Gatifloxacin-Prednisolone (Gatiquin-P)
Small torch 1
Spray bottle 500 ml 2
Unbreakable plastic trays 5
Ear buds pack 1
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10
Tracheostomy and Oesophagotomy in Cattle
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Ajay Kumar Gupta
TRACHEOSTOMY
Tracheostomy refers to the surgical creation of an opening into the trachea, whereas the term tracheotomy refers to an incision
in the trachea. Many surgeons use these terms virtually interchangeably.
Indications
Tracheostomy may be an emergency procedure in a situation of upper airway obstruction (due to snake bite, abscess of
regional lymph node, nasopharyngeal neoplasia etc.) or an elective procedure (following nasal surgery, during laryngeal surgery,
intraoral surgery or whenever post-operative respiratory obstruction is anticipated).
Surgical Anatomy
The trachea or the wind pipe is partly cartilagenous and partly membranous tube that extends from larynx along the neck to the
base of the heart, where it divides into the right and the left bronchi. It also gives off the apical bronchus at the level of 3rd rib to the
right lung. Trachea is kept permanently open by about 45-50 incomplete cartilagenous rings enclosed and interconnected by
fibroelastic membrane that constitutes the tracheal annular ligament. The cartilagenous rings are completed dorsally by the trachealis
muscle and membrana transversa. Behind the 5th ring the ends of cartilages meet dorsally producing a ridged condition. Cervical
part of trachea occupies the median position on ventral aspect of the neck and is covered ventrally by the paired sternothyrohyoideus
muscle throughout its length and paired sternocephalicus muscle in the lower third of the neck. Dorsally it is related to the longus coli
muscle and oesophagus, and laterally to the common carotid arteries, vagosympathetic trunk, internal jugular vein, recurrent
laryngeal nerves, tracheal lymphatic trunk and deep cervical lymphnodes. The blood supply to the trachea is through the branches of
the common carotid arteries and the veins go mainly to the jugular veins. The nerve supply is from the vagosympathetic trunk.
Anaesthesia and Control

In large animals sedation and/or local anaesthetic infiltration at the site are commonly used and the procedure is performed in
lateral recumbency or in standing position.
Site of Incision
Mid ventral aspect at the junction of the middle and upper thirds of the neck.
Surgical Procedure
If time and airway status allow, the ventral cervical site is clipped, aseptically prepared, and infiltrated with local anaesthetic. If
this is not possible, all priorities should be directed at opening the tracheal airway. A 7-10 cm midline skin incision is made at the site
where the trachea is most easily palpated (junction of the middle and cranial thirds of the cervical trachea). The paired
sternothyroideus and sternohyoideus muscles have a midline raphe. The ideal incision should part the musculature on the midline to
expose the ventral aspect of the trachea. The incision is extended bluntly by separating the sternothyrohyoideus muscles with
scissors. With a surgical blade, the membrane between the two tracheal rings is incised, parallel to the tracheal rings, over
approximately one third of its circumference. The tracheostomy tube of appropriate size is inserted and secured in place with one
loop of suture on either side of the tracheostomy tube. Another method is to remove an elliptical piece of cartilage from each of the
two adjacent rings. A semicircular piece of cartilage is excised from the cranial surface of one ring and the caudal surface of the
next ring.
For permanent tracheostomya more extensive exposure is required as all local musculature, excessive skin, and portions of 3-
4 tracheal rings are excised. After incising the skin, a section of strap muscles (sternothyroid and sternohyoid muscles) is removed,
followed by removal of one-fourth to one third of the tracheal circumference from each cartilage ring. The mucosa should be
preserved and incised on the midline. Enough skin should be excised to prevent loose skin from occluding the tracheostomy site. The
tracheal mucosa is sutured to the skin to produce the desired stoma.
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Post-operative Care
After surgery, the tracheostomy tube is removed and cleaned daily or more frequently if substantial volumes of exudate and
debris accumulate in and around the tube’s lumen. The tracheostomy site is cleaned with normal saline solution and all secretions
removed during each cleaning. Petroleum jelly/oil based antibiotic cream is liberally applied at the tracheostomy site to prevent
scalding by tracheal secretions. Systemic antibiotic and anti-inflammatory therapy is also indicated. The tube is removed once the
primary respiratory obstruction is resolved, and the tracheostomy site is allowed to heal by second intention.
Figure 10.1: Tracheostomy
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Complications
Infection is the likely complication, if attention is not paid to post-operative cleaning of tracheostomy tube and tracheostomy
site. Emphysema of subcutaneous tissue can develop if air leaks along the fascial planes, but is self limiting. Tracheotomy stenosis,
due to formation of excessive amounts of granulation tissue, is the potential complication and depends on the length of time the
tracheostomy tube is left in place and the width of incision.
OESOPHAGOTOMY
Indications
Oesophageal obstruction, oesophageal diverticulum, oesophageal stenosis, oesophageal neoplasia etc. are the common
indications of oesophagotomy.
Surgical Anatomy
The bovine oesophagus (Gullet) is 75-105 cm long musculo-membranous cylindrical tube, divided into cervical and thoracic
parts, extending from the pharynx to the cardia. Because the rumen is closely related to the diaphragm, no appreciable
intraabdominal portion of the oesophagus exists. Cervical oesophagus begins at pharynx in the median line and passes backwards
and downwards on the dorsal surface of trachea till about the level of 3rd or 4th cervical vertebrae. At this level it crosses the
trachea obliquely placing itself along the left side up to the thoracic inlet. The thoracic part begins at the level of 1 st rib, continues up
to 2 nd or 3 rd thoracic vertebrae, where it again crosses the left face of trachea obliquely upwards to gain its dorsal surface. It
courses in the mediastinum, passing dorsal to the base of the heart and tracheal bifurcation. The oesophagus crosses the aortic arch
and continues caudally through the oesophageal hiatus at the level of the eighth or ninth intercostal space. Structures that accompany
the cervical oesophagus include the trachea and recurrent laryngeal nerve ventromedially, longus coli muscle dorsally, tracheal
lymphatic trunk, deep cervical lymph nodes and carotid sheath containing common carotid artery, vagosympathetic trunk, internal
jugular vein laterally. In the caudal mediastinum, the oesophagus is adjacent to the dorsal and ventral trunks of the vagus nerve.
Dorsally, it is in proximity to the large caudal mediastinal lymph nodes. The oesophagus comprises of four layers that include the
outer adventitial layer, muscular layers, submucosa and a thick mucosal layer that is thrown into longitudinal folds when empty. In
the thoracic oesophagus the adventitial layer is replaced by a serosal covering, which is formed by the mediastinal pleura. In
ruminants, except at the cranial and caudal ends, the tunica muscularis comprises the outer and inner spiral layers of striated muscle
fibers that run throughout the length of the oesophagus. At the cranial and caudal ends, the inner muscle layer consists of circular
fibers, whereas the outer layer consists of longitudinal fibers. Blood supply is from the cranial thyroid, common carotid and
bronchoesophageal arteries. Nerve supply is from the branches of the vagus, sympathetic and recurrent laryngeal nerves.
Anaesthesia and Control

Sedation and local infiltration at the site is sometimes adequate for cervical oesophagotomy in standing position or right lateral
recumbency. General anaesthesia and positive pressure ventilation are essential for a thoracic oesophagotomy.
Site of Incision
The incision site is along the superior or inferior border of jugular furrow close to the level of obstruction on the left side of the
neck for cervical oesophagotomy. A left-sided rib resection is usually performed for the thoracic oesophagotomy.
Surgical Procedure
A lateral or ventrolateral approach is typically described for performing a cervical oesophagotomy. As the oesophagus is
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normally a flaccid tube that is difficult to recognise among the cervical muscles, it must be made visible by inserting a stomach tube
up to the level of the obstruction prior to anaesthesia. The neck is prepared for aseptic surgery. An incision about 3-4 inches long is
made along the superior or inferior border of left jugular furrow cutting through the skin and cervical cutaneous fascia. The
oesophagus can be approached either between the trachea and sternocephalicus muscle, or between this muscle and the jugular
vein. The oesophagus is recognized by its characteristic pink colour. The affected area is isolated from the surgical field using moist
sponges. The wall of the oesophagus is incised longitudinally over the desired length cranial or caudal to the obstruction to get into
the lumen and the obstruction is relieved.
Figure 10.2: Oesophagotomy
Primary closure is recommended if the oesophageal wall has a normal appearance. If considerable dead space exists, a closed
suction drain is advised for the first 48-72 hours. If the oesophageal wall is compromised, it should be allowed to heal by second
intention with daily wound care. Primary oesophageal closure involves a 2-layer technique. The mucosa and submucosa are closed
together in either a simple continuous or simple interrupted pattern. A synthetic absorbable ( e.g., polyglactin-910, polydioxanone or
polyglyconate) suture material is preferred. It is recommended the knots be tied within the oesophageal lumen to prevent
contamination of the wound by ingesta migrating along suture tracts. The muscular layer can be closed by using either an absorbable
or nonabsorbable noncapillary suture with a simple interrupted or mattress pattern. Skin is closed in a routine manner.
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Post-operative Care
Food and water are withheld and adequate fluid therapy is given for several days; and soft foods must follow until healing is
complete. Proper wound care, a course of antibiotics and anti-inflammatory medication is recommended.
Complications
Possible complications include wound dehiscence resulting in fistula, and stenosis of oesophagus due to scar formation.
Special Considerations
Unfortunately, oesophageal surgery in any species is fraught with complications. Most of the oesophagus does not have a
serosal covering, which is important in forming a fibrin seal. Furthermore, the esophageal lumen is not clean; constant movement
occurs during swallowing, and its location causes tension on any suture line. The proximity of the recurrent laryngeal nerve to the
oesophagus can have deleterious effects on manipulations. Once the muscular coat is incised, the oesophagus separates into two
layers: the elastic inner layer, which is composed of mucosa and submucosa, and the outer muscular layer and adventitia. The inner
layer provides the greatest tensile strength during oesophageal closure. Preservation of blood supply, aseptic technique, apposition of
tissues without tension, and appropriate perioperative management are essential for a successful outcome.
11
Foreign Body Syndrome in Bovines
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R.N. Chaudhary
Ingestion of foreign bodies by large ruminants causes a variety of problems in digestive system. Previously, foreign body
syndrome (FBS) was synonymous to traumatic reticuloperitonitis (TRP). However, in the present era, when non-degradable plastic
is being extensively used, it is a common foreign material to be ingested by bovines (mainly stray cattle). There are two types of
foreign bodies often ingested by bovines - potential and non-potential. Potential foreign bodies (like wire, nail, needle or any other
sharp stiff metallic/non-metallic object which is able to penetrate the GIT) cause TRP and its associated complications. However,
non-potential foreign bodies (polythene bags, rope pieces, cloth pieces etc.) mainly cause either impaction of rumen or obstruction of
rumeno-reticular orifice, popularly called as plastic menace in cattle.
The problem of FBS in bovines arises because of indifferent manners of prehension, little mastication and peculiar arrangement
of gastric apparatus. Lack of grazing land and the practice of intensive management have led to increasing tendency of maintaining
large ruminants under stable condition, and on dry feed for longer period during the year. This, coupled with mechanization of
agriculture and consequent increase in the metallic debris in the feed and fodder, seems to increase the occurrence of TRP each
year. Adult dairy cattle and buffaloes are most commonly affected because of their longer exposure to foreign materials with age. In
India, incidence of TRP appears to be higher in buffaloes than in cattle, however, polythene menace is higher in cattle than in
buffaloes.
Pathogenesis
Once a potential foreign body reaches the fore-stomach, it lodges in the honeycomb of the reticulum. The vigorous contractions
of the reticulum aided by the movement of diaphragm make thin sharp hard objects to penetrate through the reticular wall. The most
common sites of penetration include antero-ventral wall, ventral wall or anterior wall of the reticulum. The number of lesions is
directly related to the number of foreign bodies. Perforation of the wall of reticulum, followed by contamination of peritoneal cavity,
cause an acute local peritonitis, which may spread to cause diffuse peritonitis or remain localized to cause subsequent damage like
vagal indigestion and diaphragmatic hernia. Penetrating foreign bodies may proceed beyond peritoneum and damage other organs
causing several complications viz. reticular abscess, reticular fistula, diaphragmatic hernia, diaphragmatic abscess, traumatic
pericarditis (TP), traumatic sternebrae, pyothorax, abscessation of liver and spleen, traumatic pneumonia and pleurisy.
The inflammatory changes in the peritoneal cavity lead to formation of adhesions, which play an important role in causing
symptoms of inappetance to anorexia. Extensive adhesions of reticulum and/or rumen with diaphragm and other organs like
abdominal wall might interfere with their contraction, eructation process and the outflow of ingesta to the lower digestive tract. Due
to digestive disorders and inappetance for many days, the metabolic profile of such animals is likely to be compromised.
Non-potential foreign bodies like nuts, coins and stones lie harmlessly and may be passed out in the faeces. However, the
materials like plastics, cloths, ropes, leather pieces get accumulated in the rumeno-reticulum. The movement of the fore-stomach
churns these materials and a very hard space occupying bulk is formed. It occupies most of rumeno-reticular space and very less
space is left for ingesta proper. The ruminal microflora is disturbed and sometime reticulo-omasal orifice may be occluded leading to
cessation of faeces after a few days.
Diagnosis
Clinical Signs
A wide variation exists in the extent and intensity of clinical picture of FBS depending on the extent of injury, duration of illness,
anatomical and physiological status of the organs involved and pregnancy status of the animal. Most of the animals with TRP are
dull, depressed and appear stiff. The temperature and heart rate may be increased. There is rapid drop in the milk yield, anorexia,
ruminal and reticular atony leading to ruminal impaction with slight tympany and absence of cudding, protrusion of neck, disinclination
to lie down. Spontaneous grunting accentuated by movement, defaecation, micturation and becomes very marked on pinching
withers or applying pressure to xiphisternal region. Such animals have abducted elbows with the hind limbs held more under the
body. Sometimes, trembling of muscles over left side on the back of elbow, occasionally over the rumen and rarely on both sides is
noticed. In chronic peritonitis, there is repeated attacks of indigestion or reduced milk production. The tension of abdominal muscles
leads to ‘gaunt’ or ‘tucked up’ appearance. Symptoms like short stepping and rarely, crouching and kicking at the belly may also
occur.
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Figure 11.1: Radiograph Showing Potential Foreign Bodies in the Reticulum.

The animal suffering from plastic menace is usually weak, anaemic, debilitated and sometime recumbent when reported for the
treatment. There is no history of fever. Animal passes scanty faeces with straining. On abdominal palpation, rumen is hard, impacted
and can not be pressed even with fist.
Radiography and Ultrasonography

A plain radiograph of the reticular area is the best tool to diagnose TRP. Good quality radiographs of diagnostic value are easily
obtained preferably in lateral recumbency. Radiograph of reticular region obtained in standing position may not be of much diagnostic
value.
A healthy bovine reticulum appears ultrasonographically as a half-moon shaped structure with a smooth contour that contract at
regular intervals. When relaxed, the reticulum is situated immediately adjacent to the diaphragm and ventral abdominal wall. The
reticular contents are partly gaseous, so cannot be seen on ultrasonogram. Both the radiography and ultrasonography are not very
useful in diagnosing the FBS due to non-potential and non-metallic foreign bodies.
Hematological and Biochemical Profile

In early cases of TRP, TLC is in normal range while neutrophilia is seen with a large number of unsegmented neutrophils. In
early acute diffuse peritonitis, the neutrophil-lymphocyte ratio is reversed and decreases as the lesion becomes more chronic and
adhesions develop.
Cows with TRP have elevated titrable acidity in milk and increased standard bicarbonate, decreased potassium and chloride
concentration in plasma. In affected animals the mean total plasma protein remains on the higher side of normal range (> 80g/L)
with increase in total globulin. The plasma fibrinogen concentration is generally over 8 g/L and on gluteraldehyde test, clotting in
most of the animals occurs within 6 minutes. Trypsin inhibitor concentration in blood is substantially elevated and this may be used
for screening the animals showing clinical signs of TRP as either positive (> 8 g/ml) or negative.
There is reduction in pH, infusorial count, volatile fatty acids and ammonia content of the rumen fluid. The amount of peritoneal
fluid is increased. The physical characteristic and cellular contents of the fluid is altered. A relatively accurate diagnosis of peritonitis
can be made if the nucleated cell count is > 6000 cells/µl and a total protein concentration is > 3 g/dl. A more accurate diagnosis can
be made by performing a differential cell count and if neutrophils account for > 40 per cent of the cells and eosinophils for < 10 per
cent, a diagnosis of peritonitis is indicated. A variety of bacteria like Corynebacterium pyogenes, Spherophorus necrophorus ,
Escherichia coli and Salmonella species may be found in the localized lesions caused by perforation of the reticulum. In cases of
plastic menace there will not be any marked alteration in haemato-biochemical profile of the affected animals.
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Differential Diagnosis
The other diseases which present manifestation like TRP are atony of rumen or intestine, gastric/intestinal flatulence
acetonemia, acute metritis and metroperitonitis, peritonitis from external trauma, lying down condition of animal due to painful feet,
penetration of involuted uterus and vagina with catheter, postoperative peritonitis, perforation of abomasal ulcers, penetration of
rectum by any foreign body, tubercular peritonitis, ephemeral fever, pyelonephritis, hepatic and splenic abscesses. The complete
history with careful observation of clinical signs, critical examination combined with laboratory and radiographic findings help in
distinguishing these diseases from TRP.
Treatment
Generally, two methods of treatment are used for TRP, conservative treatment and surgery, but combination may be used
effectively. It is better to treat the animal conservatively for the first 3 days, and if marked improvement has not occurred by that
time laparorumenotomy may be performed. In conservative treatment, the animal is immobilized for two weeks, no walking is
permitted, front feet are elevated and broad spectrum antibiotics, analgesics and rumenotorics are administered. A fasting for initial
three days may be recommended. Laparorumenotomy is the treatment of choice in cases of plastic menace and in animals with last
trimester of pregnancy.
Figure 11.2: Laparorumenotomy in a Buffalo.

If the laparorumenotomy is accomplished in early phase of the disease, 100 per cent recovery is anticipated. Even reticular and
perireticular abscesses, and extrareticular fibrous nodules can be treated during laparorumenotomy. Animal’s health returns to
normal in most of the cases.
12
Medial Patellar Desmotomy
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Abhishek Chandra Saxena
Medial patellar desmotomy is a surgical incision to severe the medial patellar ligament in the animals suffering from
dorsal/upward fixation of patella.
Local Names
Jhanak, Sarnail, Ragda, Tanch, Tanak.
Indications
Upward/Dorsal fixation of patella.
Etiology/Predisposing Factors
Exploitation activity
External trauma leading to laceration or elongation of the ligamentous structures
Breed and genetic predisposition
Faulty conformation of the hind limb
Morphological changes of the medial trochlear ridge of femur
Damage to the nerve supplying the quadriceps femoris muscle.
Symptoms
Upward fixation of patella can be unilateral or bilateral, and can be permanent or recurrent in nature. It occurs mostly in
buffaloes but is also reported frequently in young working bullocks. In horses, it occurs most frequently in young ponies working on
hills and in animals with a faulty conformation of the hind limbs.
Recurrent dorsal fixation is not apparent in resting animals in which the patella occupies its normal position in relation to the
femoral trochlea. It is manifested during progression by an intermittent fixation of the patella through the hooking of the medial
patellar ligament over the prominent upper extremity of the trochlear ridge. When the animal is forced to move, the condition
becomes evident by occasional jerky steps during otherwise normal progression. It frequently disappears as the animal “warms up”.
In due course as the condition progresses, the symptoms become more frequent and the gait more obviously disturbed. Stifle and the
hock joints are periodically fixed in extension and this gives the limb an unusual rigidity, while over-flexion of the fetlock causes the
toe of the hoof to drag upon the ground during progression.
Animals suffering from permanent dorsal fixation, when forced to walk, carry their leg rigidly with the fetlock flexed and the
toe dragged on the ground with the weight supported by the flexed digit. After some time, animal adapts its gait by bringing the limb
forward in abduction in the swinging phase, without flexion of the hock and stifle joints. When an attempt is made to back the animal,
it often refuses to move.
Clinical Examination
On clinical examination of the animals having recurrent dorsal fixation, the patella is found to be unusually mobile and in these
cases it can readily be carried dorsally by slight manual pressure. If this is done and the animal is induced to move, the typical
“locked” gait is seen and later, when the patella frees itself, a thudding sensation may be detected. The symptoms may be induced to
appear in an exaggerated form by circling the animal with the affected limb on the inner side, while circling in the opposite direction
with the affected limb outermost, lessens the symptoms.
Anatomy of Stifle Joint
Stifle joint consists of two major articulations viz. femoro-patellar and femoro-tibial. The femoro-patellar joint is formed
between trochlea of the femur and articular surface of the patella. Patella is connected to the cranial tibial tuberosity by patellar
ligaments. The patellar ligaments are medial, middle and lateral. In blind method of surgery, it is very important to identify and
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palpate the medial patellar ligament.
Surgical Procedure
Main aim of medial patellar desmotomy is to dislodge the patella from medial trochlear ridge, thus leading to free movement of
stifle joint. Surgery can be performed with the animal in the standing position or in lateral recumbency. There are two common
methods to this surgery viz. blind/closed method and open method.
Figure 12.1: Front View of Stifle Joint.
1. Parapatellar fibrocartilage; 2. Patella; 3. Medial patellar ligament; 4. Attachment of biceps femoris; 5. Medial
trochlear ridge; 6. Lateral patellar ligament; 7. Middle patellar ligament; 8. Cranial tibial tuberosity.
Standing Approach with Blind Method

The site of the skin incision is indicated by a small depression that may be felt between the middle and medial patellar ligaments
above their insertion on the tibial tuberosity. The operational site is shaved and painted with tincture of iodine. Local anaesthetic (2
per cent lignocaine, 2-5 ml) is injected subcutaneously over and around the ligament. Sterile surgical gloves are worn and the usual
aseptic precautions observed. A small incision is made in the skin between the middle and medial patellar ligaments just proximal to
the tibial tuberosity, taking care not to penetrate the joint capsule.
A tenotom is then pushed through the skin incision under the medial patellar ligament, near its insertion at tibial tuberosity, with
its cutting edge in vertical direction. Once positioned correctly, the cutting edge is then directed towards the ligament. The tenotom is
then slowly moved while strongly pressed against the ligament, which is normally transected in a single movement of the blade.
Severance of the ligament is indicated by the development of a deep depression between the cut ends. If the ligament is not
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completely transected the procedure is repeated.
Blind Method in Lateral Recumbency

In uncooperative patients, it is difficult to perform surgery in standing condition and such animals are cast and restrained on the
ground with the affected limb at lower side. Forelimbs and the upper hind limb are tied together, and the affected limb is extended
backward by pulling a rope tied at the region of fetlock. Pushing the point of hock towards the ground, rotates the stifle joint to better
expose the site of incision. Cranial tibial tuberosity is located and the groove between the medial and middle patellar ligaments is then
palpated. In this position, medial patellar ligament occupies the topmost position and is traced easily. Surgery is then completed in the
same manner as in standing approach.
Open Method
In open method, after aseptic preparation of the surgical site on the affected limb and infiltration of local anaesthesia, a 3 cm
linear incision is given 0.5 cm lateral to the medial patellar ligament near its insertion on the tibial tuberosity. Artery forceps are used
for blunt dissection of the fascia from underneath the medial patellar ligament, and the ligament is then lifted over the forceps. After
properly exteriorizing the ligament, it is cut transversely using a scalpel. The skin incision is closed by a few interrupted sutures.
Post-operative Care
Daily antiseptic dressing of the surgical wound and post-operative antibiotic cover, especially after open method, is all that is
needed post-surgery. The results are miraculous and animal walks without a limp immediately after successful surgery.
Possible Post-operative Complications

Transaction of middle patellar ligament
Transaction of collateral ligaments
Penetration of joint capsule
Haemorrhage
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Infection
13
Surgical Management of Intestinal Obstruction
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H.R. Bhardwaj
Intussusception is the invagination or telescoping of the one segment of bowel into the lumen of its adjacent segment and is the
frequent cause of intestinal obstruction in cattle.
The intestinal obstruction implies to the failure of the intestinal contents to move in a normal aboral direction. The morbidity and
mortality in intestinal obstruction cases varies considerably and depend on the type of obstruction, location of obstruction in the
intestinal tract and its duration.
Etiology
Etiological factors of intestinal obstruction include conditions such as enteritis and increased peristalsis, intestinal parasitism,
abrupt dietary changes, drug induced changes in intestinal motility, mural or luminal lesions, impacted food material, abscessaton,
foreign bodies and tearing of mesentery and trapping of intestinal loop.
Pathophysiology
Accumulation of ingesta in higher segment of obstructed intestine results in distension of abdomen. The right side of abdomen
enlarges as a result of distension of small intestine with fluid. The fluid, gas and digesta that accumulate proximal to the obstruction
arise from sources including saliva, swallowed air, pancreatic and bile secretion, gas from bacterial fermentation, ingested fluid and
solids and secretions from intestinal mucosa. Absorption from bowel immediately above the obstruction is hampered while secretions
continued in normal amounts. Secretions accumulate in the bowel lumen and result in dehydration. Signs of early colic had been
reported to be caused by tension on the mesentery from the invaginating portion of the intestine. With the passage of time, ischemia
of the invaginated portion leads to loss of sensation from tension receptors.The rumen becomes distended with fluid regurgitated
from abomasum.
Clinical Signs
The most important clinical signs of intestinal obstruction in cattle is scanty faeces, which often contain blood and mucous, and
sausage-shaped mass may be detected upon abdominal palpation.
Figure 13.1: Perrectal Examination-Mucus with Tarry Colour Faeces.

The reticulo-ruminal contractions have been reported to be suppressed and may persist with reduced vigour throughout the
course of disease in intestinal obstruction affected animals. History of anorexia has been reported in all the animals of different
species suffering from intestinal obstructions. A cow suffering from intestinal obstruction passes no faeces. The bovines suffering
from intestinal obstruction in first few hours, exhibits signs of colic characterized by violent behaviour or forceful kicking at belly with
hind legs. Frequent sitting and standing up, paddling of limbs, stretching, recumbency and arching of back.
Diagnosis
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Intussuscepted mass had been reported to be palpable in only minority of affected adult cattle, although, distended loops of
small intestine are palpable per-rectal in 50 per cent of cases suffering with intussusception. Diagnosis is also done on the basis of
clinical signs such as colicky pain, anorexia and absence of faeces. Moreover, the intestinal obstruction cases can be diagnosed on
the basis clinical and laboratory findings.
Figure 13.2: Preparation of Cow for Intestinal Surgery through Right Paralumber Fossa.
Figure 13.3: Exteriorized Obstructed Mass.

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Figure 13.4: Decompression of Gas Filled Oral Part of the Intestine.
Figure 13.5: Removal of Intussuscepted Mass.

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Figure 13.6: Inner Invaginated Layers after Resection which Shows Necrosis.
Surgical Treatment
Small intestinal obstructions have been reported to be repaired surgically by means of enterotomy or enterectomy, i.e. resection
and end-to-end entero-anastomosis or side to side anastomosis. These traditional techniques have been demonstrated as time
consuming and have also resulted in increased chances of anastomotic leakage; over expose the surgical site and thus cause the
unnecessary trauma to increased proliferation of enteric bacteria leading, causing peritonitis, adhesions, leakage, seepage and
ultimately mortality.
Figure 13.7: GIA Stapling Devices.

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Figure 13.8: Surgical Incision at Right Flank to Approach Abdomen.
Figure 13.9: Insertion, Locking and Firing and Sectioning with GIA Stapling Device.
Recently, stapling technique has been demonstrated as better technique and can be used at field level as it consumes less time
in construction of anastomosis, causes less tissue trauma and prevents prolonged exposure of surgical site to the environment.
Moreover, we have bypassed intussuscepted mass in treatment of intussusception. The main advantage of bypass intussusception
anastomosis using stapler is reduced risk of mesenteric bleeding. The other advantages of use of stapling devices for entero-
anastomosis include short surgical time, less tissue trauma, least intra-operative contamination, protection of vasculatures and
eventually early restoration.
Intussusception Bypass Surgery

Intussuscepted part of the intestine is exteriorized through the incision on the right flank. The parts oral and aboral to the
intussusception are identified and small nick incisions are made on both these parts.
The limbs of the stapler are withdrawn after joining the bowel segments and double staggered anastomotic staple lines
surrounding the created stoma. The nick incisions are closed with 1-0 chromic catgut.
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Figure 13.10: Intussusception Bypass.

Routine post-operative care is given. No intra-operative complication is generally seen.
14
Ventral Herniorrhaphy
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A.K. Sharma
Ventral or lateral abdominal hernia is a term used to describe a hernia through any part of the abdominal wall other than a
natural orifice. If the hernia is ventral to the stifle skin fold, it is termed as ventral hernia and the rest, e.g, in the flank region, are
known as lateral abdominal hernias. Such type of hernias are common in ruminants and are generally acquired in nature.
Any trauma such as a kick in the camel, horn thrust in cattle or violent contact with blunt objects or an abscess in the abdominal
cavity may lead to weakening of the abdominal wall subcutaneously. Abdominal distension due to pregnancy or violent straining
during parturition may lead to ventral hernia, especially in sheep. An excessively long caudal flank incision for caesarean section in
the camel may subsequently cause hernia.
Ventral or lateral hernia is commonly seen along the costal arch, high or low in flank, between the last few ribs or in the ventral
abdominal wall near the midline. Size of the hernial opening varies in diameter. It is difficult to palpate the ventral hernial ring during
initial stages due to oedema or haematoma in the surrounding tissues. Therefore, it is necessary to wait for the inflammatory swelling
to subside before examination is done to confirm the diagnosis. This delay may also facilitate repair as recently traumatized tissues
do not hold suture firmly. The hernial sac, formed by the skin and subcutaneous tissues, may or not be lined with the peritoneum.
Lack of a peritoneal covering favours the development of adhesions between the viscera and sac, and finally cause incarceration or
strangulation. The nature of hernial contents depends on the site of the herniation. A hernia in the left flank may contain the rumen.
In most cases, the condition is harmless and constitutes an unsightly blemish, which is prone to traumatic injuries.
Figure 14.1: Ventral/Umbilical Hernia in Calves.
Treatment
The principles of surgical correction of hernia include:
Return of viable contents to their normal position in the abdomen
Secure closure of the neck of hernia, preventing recurrence
Obliteration of the redundant tissue in the sac
Use of patients own tissue wherever possible
When the hernia is apparently harmless, herniorrhaphy is elective and not an emergency operation. It is advisable to delay the
surgical repair for at least a week after injury as has already been discussed. However, prolonged delay may cause complications
due to loss of muscle elasticity and adhesions sue. If the hernia is complicated due to incarceration or strangulation, immediate
surgical intervention is required.
After a linear incision, the skin is freed from all around the swelling. The sac is separated from the ring by blunt dissection and
incised. The viscera is freed of any adhesion and returned into the abdominal cavity. The thick mass of fibrous tissue involving the
hernial swelling may be resected at the level of the ring and discarded. The edges of the ring are trimmed to provide a raw surface
for healing.
The rent in the abdominal wall is then closed by overlapping the edges with a heavy suture material using the technique similar
for umbilical hernia. Interrupted sutures can be placed between the overlapping sutures for reinforcement. Excess skin of the sac is
removed, and the subcutaneous tissue and skin are apposed with simple continuous and horizontal mattress sutures, respectively.
Far-near-near-far tension sutures of 2 No. polydioxanone are used to appose body wall defects. A sterile drainage tube may be
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placed subcutaneously to prevent accumulation of fluids.

Extensive ventral or lateral hernia may require hernioplasty. Nylon mesh anchored over the defect has proved satisfactory. If a
large part of the rumen gets herniated in the flank region, surgery may not be feasible.
Post-operative Management
The amount of feed should be reduced to half for about a week after surgery. A supportive bandage may be placed around the
abdomen to relieve tension on the healing tissues. The suture line is treated on general principles of wound care.
Complications are infrequent if the surgery is performed with judicious attention.

Haematoma: Due to inadequate haemostasis intraoperatively
Seroma: Due to inadequate obliteration of subcutaneous dead space
If the above problem occurs, adopt “Wait and See” approach. Otherwise benign seromas or haematomas may easily get
converted to abscesses
Umbilical herniorrhaphy is a straightforward procedure with an excellent prognosis for life and function at any level of
activity.
Figure 14.2: Repair of Large Hernias using Biomaterials.
Open Reduction of Hernia

With the availability of safe anaesthetic techniques and improved suture materials, there is little indication for employing a
method which is less than certain to correct the hernia. An elliptical incision extending 2 cm beyond the margin of hernial ring
cranially and caudally is given. Sutures are inserted 1-2 cm from the edge of the ring and are carried through the full thickness of
abdominal wall. Mesh is best placed in an extra-peritoneal position between the internal rectus abdominus muscle sheath and
peritoneum. This has greater mechanical advantage than if placed over the defect. Procedure is facilitated by preplacing all the
sutures in the mesh.
15
Atresia Ani and Rectovaginal Fistula
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Prakash Kinjavdekar
ATRESIA ANI
Atresia is a term that describes a body orifice that is abnormally small or completely closed. Intestinal atresia is a very serious
disorder and it is the most common abdominal disease in calves less than 8 days old. Calves born with a form of intestinal atresia can
appear normal at birth, but they develop signs 24-48 hours later and most often die within hours of birth if the problem is not
surgically corrected.
Atresia ani is defined as the presence of a very small opening or no opening at all at the anus due to a failure of the anal
membrane to break down. It is a congenital abnormality, manifested clinically by an absence of faeces, dullness, anorexia with
abdominal distension, discomfort and straining at an attempt to defaecate. Atresia coli is a similar condition, where a segment of
colon is missing. Both these conditions can be present either alone or in combination with other congenital disorders like rectovaginal
fistula.
Etiology
Both atresia ani and atresia coli are congenital defects, which arise due to insult during foetal development and it is thought that
atresia ani is an inheritable defect in cattle. There are reports of breed predilection related to the incidence of this condition and
Holstein-Friesian calves are at a greater risk than other breeds. Another possible etiological factor includes damage to the amniotic
vesicle during early pregnancy palpation leading to damage to the blood supply to the foetal intestine.
Figure 15.1: A Calf with Atresia Ani.
Symptoms
Calves with atresia ani can show severe signs within hours of birth, while symptoms of atresia coli usually do not appear until
24-48 hours after birth. The affected calf will be unable to pass any faeces so it takes some time for faeces to build up and cause
clinical signs. Typical signs of intestinal atresia include decreased appetite, progressive bilateral abdominal distension, the absence of
faeces, episodes of straining to defaecate, and occasionally blood-tinged mucous can be found around the rectum. The most
characteristic clinical sign is bulging of rectal lumen usually subcutaneously at the normal site of the anus when the abdomen is
compressed.
Diagnosis
Lateral abdominal radiograph in calves affected with atresia ani will show a distended, faeces-filled colon with an abrupt end at
the level of the rectum. However, abdominal radiographs of calves with atresia coli will show enlarged loops of bowel and absence
of faeces in the rectum. Sometimes, giving a barium enema prior to radiography of the abdomen can help determine the level of the
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defect in cases of atresia coli. Animals with atresia ani are usually easier to diagnose since they will show signs early on and
sometimes the imperforate membrane can be palpated.
Surgical Treatment
Treating atresia ani and atresia coli involves surgically opening the blocked orifice. The defect in atresia coli is usually at the
level of the spiral loop of the ascending colon, so correction involves removing the defective section of the bowel and reattaching the
normal sections. Unfortunately, surgical correction of atresia coli has a poor overall success rate, with a short-term survival rate of
less than 50 per cent and a long-term survival rate of less than 35 per cent.
Figures 15.2 and 15.3: Incision for Correction of Atresia Ani; After Correction.
For surgical correction, 2-3 ml of 1 per cent lignocaine solution is injected epidurally, and the animal is restrained in sternal
recumbency with the hind feet pulled in a slightly cranial direction. After routine aseptic preparation of the surgical site, a 1-2 cm
diameter circular incision is made through the skin and subcutaneous tissue at the site where the anus would normally be located.
The skin edges are retracted with Allis forceps held by an assistant. A distended blind-ended rectum is easily located by digital
exploration in pelvic midline. Careful blunt dissection in a cranial direction is carried out, followed by gentle pulling of the rectal
pouch with a pair of tissue forceps (rectal pull-through procedure) in a caudal direction. If this does not allow the rectum to be
identied, it may be grasped via left ank exploratory celiotomy and moved in a caudal direction by simultaneous traction through the
pelvic canal and manipulation in the abdomen. The rectum is sutured to the subcutaneous tissue with four interrupted sutures placed
dorsally, ventrally and bilaterally into the rectum to maintain it in position and then rectal pouch is incised vertically for 1-2 cm length,
which will lead to spurting of meconium from the lumen. The extra-rectal meconium should be removed with damp swabs, but the
wound should not be irrigated as it could push infection cranially. Maintaining a lumen of minimum 2 cm diameter may require
frequent dilatation of the opening for several weeks because surgical wound healing results in localized necrosis.
Intraoperatively, the presence of anal sphincter muscles is rarely evident. Faecal incontinence is therefore a frequent
complication of surgical correction of atresia ani. A single stab incision through the perineum into the rectum is not successful, as
stricture and obstruction are likely to occur. If there is a sizable portion of rectum (and descending colon) missing, surgery is
exceedingly difficult because the short mesocolon does not readily stretch, and in such cases, surgery should be discouraged. Before
suturing the rectum to the perineal skin, any rectovaginal or urethral fistula needs to be located and transected in the female. This is
usually done easily by exploring the vaginal opening and fistula with a blunt instrument.
Post-operative Care
Broad spectrum antibiotic is administered for 3-5 days to prevent surgical wound infection. Topical application of povidone
iodine solution as well as fly repellant cream around the wound region is advised. Dilatation of the anal opening by frequently
inserting a finger to prevent any stricture formation due to wound contraction is also advised.
Prevention
Preventing intestinal atresia in cattle cannot be fully accomplished because the causes of this abnormality are not fully
understood. However, there are measures to take to reduce the incidence in a herd. Given the Holsteins have an increased
incidence of atresia coli, it is evident that it may be an autosomal recessive trait in the breed. Hence, it is advisable to cull any
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affected calves and not attempt surgical correction of atresia coli. Additionally, the possibility that damage of blood supply to the
developing faetal intestine during the first 6 weeks of pregnancy can cause atresia coli, warrants gentle palpation techniques during
this sensitive period of gestation.
RECTOVAGINAL FISTULA
Rectovaginal fistula is a fistulous tract that connects the vagina and rectum. It has been reported to occur in many species but
the condition is more common in mares than in most domestic animals. During parturition, the front foot of foal/ calf, in an anterior
dorsosacral presentation, typically perforates the dorsal aspect of the vestibule and enters the rectum. The foot is withdrawn and
leaves a defect between the rectum and vagina. It can also occur at parturition when the annular fold of the hymen at the
vaginovestibular junction obstructs passage of the foal’s forefoot or nose. Rectovaginal fistula has been also reported to be seen
usually in conjunction with imperforate anus (atresia ani) in neonatal animals.
Although minor laceration to the perineum does not require surgery, major ones will affect reproductive performance and
require surgical correction. Unlike some other species, the constrictor vestibuli muscle and cervix of the cow help prevent infection,
which allows some cattle with complete perineal lacerations to become pregnant.
Etiology
Most of the rectovaginal injuries occur at the time of foaling, either as a result of an oversized or malpositioned foetus, or
because of excessive manipulation during assisted delivery. Rectovaginal fistula can also be encountered as a complication arising
due to failure of third-degree perineal laceration repair. Severe trauma that leaves a wide opening between the rectum and vagina
has also been reported, but are rarely encountered in clinical practice.
Figure 15.4: Rectovaginal Fistula in a Calf.
Diagnosis
In newborn animals, there may be clinical signs of passage of faeces through the vulva, and sometimes the owner complaints
that faeces and urine are coming through a common vaginal opening. Diagnosis may be confirmed by barium enema, which outlines
the extension of the defect into the vagina.
In cases with history of recent assisted foaling in mares, there are increased chances of getting this condition. Faecal
contamination of the reproductive tract commonly results in vaginitis and endometritis, and loss of the constrictor vulva muscle or
functional rectal sphincter, or both, leading to pneumovagina/wind sucker condition.
Surgical Management
Identification of the fistula, surgical correction and reestablishment of the normal anatomic structures are imperative. The
surgical management has two parts, immediate treatment and delayed surgical repair. Repair in the acute stage should be avoided as
far as possible because the tissue is very oedematous and contaminated with faeces, and some tissues may not be viable. Repair can
be delayed for 4-6 weeks to allow healing of the injured tissues because the defect size can be reduced markedly as a result of
wound contraction. Some smaller defects have been reported to heal completely. Initial therapy should include daily wound care and
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cleaning of the contaminated tissues.

For surgical repair, animal is restrained in standing stocks, the rectum is evacuated of faeces, and the tail is retracted to one
side. Some surgeons like to construct a rectal tampon from an orthopaedic stockinette filled with cotton and secured at the ends with
umbilical tape. After the administration of lignocine epidurally, the rectum is evacuated and the perineum prepared for aseptic
surgery. Perioperative antimicrobials are indicated. A transverse incision is made between the rectum and vagina. By using a
combination of sharp and blunt dissection in a horizontal plane, the fistula is exposed. Ideally 2/3 of the thickness of the shelf should
be with the rectum and 1/3 with the vaginal shelf. Dissection is continued 3-4 cm rostral to the fistula. The rectal defect is closed
transversely (because the musculature of the rectum is primarily circular and sutures placed perpendicular to the muscle fibers are
subject to less stress than the sutures placed parallel to the direction of the muscle fibers) by using No. 0/1 absorbable sutures in a
simple interrupted pattern placed in the sub-mucosa, with care taken not to penetrate the rectal mucosa. Successful repairs have
also been reported with longitudinal closure of the rectum. Either technique is adequate if there is good tissue apposition with little
tension. The vaginal defect is closed in next step. Many surgeons advocate a continuous horizontal mattress pattern in a longitudinal
direction (because its muscle fibers are primarily longitudinal) so that the two suture rows (rectal and vaginal suture layer) are at
right angles to each other and the vaginal mucosa is everted. The incised skin of the perineal body is closed with interrupted non-
absorbable monofilament sutures, which are removed 10-14 days later.
Post-operative Care
Post-operative treatment of the mare after repair of a rectovaginal fistula usually includes administration of broad-spectrum
antimicrobial drugs (Procaine penicillin G (20,000 IU/kg, IM, BID) and non-steroidal anti-inflammatory drugs like flunixin meglumine
(1 mg/kg, IV, BID) for 7 days. The mare should receive tetanus prophylaxis, if she has not received it previously. Post-operatively,
temporary atony of the rectum, pain, or solid faeces can cause constipation and increased exertion for defaecation may cause
dehiscence. To prevent this, it is important to manage the diet, administer analgesic therapy and if needed careful manual evacuation
of the rectum. Hence, faeces should be kept soft and scanty for at least 10 days by modification of the diet and administration of a
faecal softener (mineral oil or raw linseed oil). Repair can usually be safely evaluated on the 9th or 10th post-operative day. Defects
in the repair are best detected with palpation of tissue between a hand inserted into the rectum and a hand inserted into the vestibule.
Mares that strain excessively after surgery should receive epidural anlgesia and sedation, and the cause of straining should be
eliminated. Causes of straining include faecal impaction of the rectum and bacterial cystitis. Mares that are reproductively healthy
before development of a rectovaginal laceration or fistula are usually able to eliminate bacteria from the tubular genital tract within
one estrous cycle. In mares that still have a functional vestibulovaginal seal after a rectovestibular laceration or fistula, endometritis
may not develop, provided the tear is caudal to the seal. Those mares that have developed endometritis appear to be capable of
rapidly resolving inflammation after perineal repair. Natural breeding should not be allowed for at least 3 months after the repair of a
third-degree perineal laceration.
Prognosis is usually guarded. Complications are common and include faecal and urinary incontinence. Faecal incontinence
arises due to rectal stricture during healing period, while urinary incontinence arises because of ascending infection leading to
cystitis. Other complications include suture dehiscence and recurrence of the condition.
Prevention
Care and attention during difficult deliveries to reposition the foal or prevent a foot from penetrating the septum may be
possible. Make sure that anyone doing a rectal examination is well-qualified and that the mare is properly sedated or restrained.
16
Perineal Laceration and Rectal Affections
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Kiranjeet Singh and Aswathy Gopinathan
PERINEAL LACERATION
Third degree perineal lacerations in equines are most severe form of perineal injury and involve all layers of vestibule, perineal
body and rectum, with disruption of the anus. Severe anterior tears that penetrate the peritoneal cavity can lead to rapid death as a
result of massive peritoneal contamination. Those cases which are presented within 4 hours of trauma can successfully be treated
by emergency reparative surgery. Treatment at late stage (more than 4-6 hours) is invariably ineffective, as partial breakdown
mostly occurs. In such cases healing and granulation of the torn area usually takes 4-6 weeks and hence the surgery is usually
delayed till inflammation subsides completely.
Indications
Dystocia, traumatic bleeding or conversion of recto-vaginal fistula into third degree perineal laceration for subsequent repair.
Equipments
Long handled instruments and monofilament absorbable suture materials are required. Self-retaining retractors (Balfour,
modified Finichietto) and a good light source (floor lamps, head lamps or fibre-optic lights) are useful.
Figure 16.1: Photograph of the Buffalo with Second Degree Perineal Laceration before Surgery.
Preparation and Positioning

Surgery is delayed for 4-6 weeks following laceration to allow wound contraction and inflammation to subside. Delaying
surgery allows the wound edges to strengthen and become clearly defined before repair is attempted. A gruel or pasture diet is fed
3-5 days prior to surgery, and the mare is fasted 1 day before the surgery. The mare is restrained standing in a stock and surgery is
performed under epidural analgesia with or without sedation. Surgery can also be performed in a patient induced with general
anaesthesia in lateral recumbency. After induction of anaesthesia, the tail is secured and retracted. Faecal material is removed from
the rectum and vagina. The perineal region is rinsed followed by cleansing of rectal and vaginal lumens with a dilute povidone-iodine
solution. The perineal region is aseptically prepared.
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Procedure
One- or two- staged technique can be applied, former is preferred but latter should be performed when there is excessive
tension at the suture line. No distinct advantage or disadvantage exists between these techniques. Principles for all techniques
include initial creation of rectal and vaginal shelves, minimal tissue tension and maintaining a soft faecal consistency after surgery.
Figure 16.2–16.4: Photograph of a Mare with Third Degree Perineal Laceration Before Surgery.
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Towel clamps or retention sutures are positioned along the dorso-lateral and ventro-lateral aspects of the defect to provide
exposure. The cranial extent of laceration is extended 3 cm, creating a rectal and vaginal shelf. Dissection is continued laterally and
caudally along the scar tissue line into the submucosa until the tissue flaps created can be apposed on midline without tension. Both
mucosal surfaces are dissected 2 cm or more.
One Stage Repair (Goetz Technique)

Using No. 1 absorbable suture, a six bite pattern is used to close the recto-vaginal shelf. The suture pattern should begin within
the vaginal lumen, allowing the knot to be secured within the vaginal lumen. Sutures are positioned approximately 1 cm apart, the
suture pattern includes the vaginal mucosa but does not penetrate the rectal mucosa. The vaginal mucosa is closed over the newly
created recto-vaginal shelf with No. 0 absorbable suture using a continuous horizontal mattress pattern. The rectal mucosa is left to
heal by second intention. Closure of the recto-vaginal shelf and vaginal mucosa should extend to the cutaneous perineum. Caslick’s
procedure is then performed to appose the vulvar opening.
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Figure 16.5: Photograph of a Mare After First Stage Repair of Third Degree Perineal Laceration.
Two Stage Repair (Aanes Technique)

The vaginal mucosa is inverted into the vaginal lumen with No. 0 absorbable suture material using Cushing or Lambert pattern.
This suture pattern is continued caudally to reconstruct the cranial half of the defect and then tied but not cut. Using No. 1
absorbable suture, purse string sutures are made to close the recto-vaginal shelf. Sutures are positioned approximately 1 cm apart
and should not pass through the vaginal or rectal mucosa. If an excessive amount of tension or dead space is present, partial
tightening of the purse-string sutures along with saggitally oriented simple interrupted sutures will help obliterate dead space. Once
the cranial half of the recto-vaginal shelf is reconstructed, closure of the vaginal mucosa is completed, followed by closure of the
remaining caudal half of the recto-vaginal shelf. Optionally, the rectal mucosa may be inverted into the rectal lumen with No. 2-0
absorbable suture material using Cushing or Lambert pattern. Closure of the recto-vaginal shelf is continued to the level of the
cutaneous perineum.
Closure of the perineal body is performed 3-4 weeks after the first surgery if recto-vestibular shelf is completely healed. If
dehiscence occurs or a fistula is present, the first stage should be repeated. Closure of the perineal body is performed using perineal
body reconstruction technique. A triangular section of the vestibular mucosa is reflected ventrally and removed from each side, with
a triangle apex pointing cranially and the base along the mucocutaneous junction of the perineum. Closure of the ventral vestibular
mucosal margins should be performed in a cranial to caudal manner with No. 2-0 absorbable suture in a simple continuous pattern.
Deep perineal tissues should be apposed with No. 2-0 absorbable sutures using a simple interrupted pattern. Perineal skin is apposed
with No. 0 non absorbable sutures using Ford interlocking pattern.
Recently a new modification of the surgical technique has been applied and it showed healing by first intention, and subjects
had good post-surgical fertility. In this technique, the rectovestibular shelf was corrected with three parallel ‘circular’ continuous
suture rows distributed along the longitudinal axis of the vagina, and the perineal body was reconstructed with three divergent simple
continuous rows.
Post-operative Care
Exercise restriction
Medications: Tetanus prophylaxis, broad-spectrum antibiotic are administered for 7-10 days; NSAIDs for 3-5 days
Suture removal: Perineal and Caslick’s sutures should be removed 10-14 days after surgery
Dietary modification: Free choice access to grass, a gruel diet or both should be provided for 30 days with gradual return
to normal diet. Occasionally mineral oil should be added to maintain soft faecal consistency
Others: Sexual rest is recommended until the following breeding season.
Expected Outcome
Primary healing is reported to occur in approximately 70-90 per cent of repaired third degree perineal laceration cases. Short
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term complications such as dehiscence or fistula formation are reported to occur in 12-24 per cent of all surgical repairs (2, 4, 6, and
7). Third degree perineal lacerations recur in 5-50 per cent of the foaling mares due to the inelasticity of the resultant scar tissue.
Complications
Suture dehiscence and subsequent fistula development are possible. These complications can be avoided with precise
dissection, adequate tissue purchases and reduced tension on apposed tissues. Fistula formation may result in failure to conceive due
to endometritis, pneumovagina if continued faecal contamination of the vaginal lumen. Uro-vagina may be a consequence of the
mare’s natural perineal conformation or the result of altering the perineal conformation during the recto-vaginal fistula repair and can
be addressed with an urethroplasty procedure. Mares should be monitored during subsequent foaling because the fibrous tissue from
the repair may reduce the elasticity of the birth canal and predispose the mare to additional birthing trauma. As the sutures are
progressively placed in the caudal tissue, care must be taken to avoid the narrowing of the rectal lumen, which will predispose the
mare to tenesmus and constipation.
RECTAL PROLAPSE
Etiology
Prolonged tenesmus or straining due to rectal inflammation and irritation, diarrhoea, enteritis or parasites, and during act of
parturition. Intestinal neoplasia, foreign bodies, perineal hernia, constipation and congenital defects. In incomplete prolapse, only
mucosa is prolapsed and in complete prolapse, whole thickness rectal wall is involved. Prolapsed mass is more prone to ischaemia
and oedema, contamination and trauma.
Diagnosis
Protrusion of mass through anus. Many a times it is associated with vaginal prolapse. Differential diagnosis: Intussusception
with prolapse, especially in young dogs, and tumours like venereal granuloma.
Figure 16.6: Rectal Prolapse in a Buffalo Calf.
Treatment
Fresh Cases
Easy to repose
Lavage with astringent solutions and apply antiseptic ointment + lignocaine jelly before repositioning
Apply purse string suture for 2-3 days, when no signs of straining
Epidural analgesia
Laxative diet for few days
Recurrent/Chronic Prolapse
When severe necrosis, damage of the rectal tissue
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Amputation of rectum under epidural analgesia

Comlications include peritonitis from wound dehiscence, stenosis or stricture
RECTAL (SUPRA) ABSCESS

More common in horses but also reported in bovines occupying the perineal tissue, wall or floor of rectum.
Etiology
Trauma and infection or associated with strangles.
Symptoms
Swelling or mass pressing the rectal lumen resulting in colic or scanty/no faeces etc.
Diagnosis
Needle aspiration and cytological examination, and ultrasonography.
Prognosis
If abscess is located anteriorly or ventrally, it may rupture causing peritonitis. Abscessses in the lateral or dorsal wall of rectum
or towards the anus generally have good prognosis.
Treatment
Incision is given to evacuate the contents. General principles of abscess management are followed. A tube or catheter is placed
to maintain the patency of the incision over abscess. Antibiotic based on culture sensitivity test and anti-inflammatory drugs should
be administered. Laxatives are advised along with less diet for few days.
17
Management of Urolithiasis in Ruminants
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T.B. Sivanarayanan and Amarpal
Urolithiasis is one of the oldest documented miseries of the mankind. The condition has been reported from all corners of the
world and in all the species of animals. Since the disease is multifactorial in origin, its incidence varies from place to place and time
to time. Etiopathogenesis is obscure, identification of the types of calculi is not always easy, management is difficult and frustrating,
especially in ruminants, both for veterinarians and animal owners. The disease thus causes heavy mortality and consequently
economic losses to the marginal and poor farmers. Blockage of urethra leading to obstruction to urine flow is the clinical situation
demanding immediate surgical intervention. Urethral obstruction, if not relieved in time, leads to rupture of urinary bladder and
subsequently diffused, acute, severe fibrinous peritonitis. The abrupt release of large quantities of urine in the abdomen may lead to
cardiovascular disturbances resulting in death of the animal. Therefore, it is always advisable to initiate the treatment as early as
possible. Approaches to surgical management have changed in the recent past, and simpler and better techniques have been
developed, which have reduced the mortality to a great extent in cases suffering from urolithiasis. Some of the useful surgical
techniques are described in the following text.
Surgical Managements of Urolithiaisis in Goats and Calves

Urethral Process Amputation
Urethral process is reported as the most common site of calculi lodgment in goats. Urethral process amputation has, therefore,
been the most common surgical technique used as first line of treatment of obstructive urolithiasis. Though reports on extrusion of
glans penis without preputiotomy are available, it may be difficult to extrude glans penis in immature small ruminants owing to normal
attachment of glans penis to prepuce. The procedure is performed under local or lumbosacral epidural analgesia induced with 2 per
cent lignocaine. The animal is restrained in right lateral recumbency with left hind limb pulled backward. Ventral abdomen from
umbilicus to anterior border of scrotum is prepared for aseptic surgery by shaving, proper scrubbing and painting with povidone-
iodine solution. Glans penis is palpated at the tip of penis and ventral midline skin incision of 2 cm is given over the glans. Penis is
freed from subcutaneous fascia and gently pulled out. An incision is made in the prepuce to expose the glans. Urethral process is
freed from adjacent tissue. A small incision is made in the urethral process at its base and a poly vinyl chloride (PVC) catheter of
appropriate size is passed into the urethra as far caudally as possible. Urethral process is then resected from its base. The other end
of catheter is passed cranially so as it cames out through preputial orifice. Preputiotomy incision is closed by simple continuous
pattern using 3/0 PGA or catgut. Skin incision is closed by No. 1 silk suture using horizontal mattress suturing technique.
Urethrotomy
Removal of uroliths by urethrotomy is the first line of treatment in many practices. In goat urethrotomy is usually performed at
post-scrotal site as almost entire length of urethra can be examined through this site. The animal is restrained on the operation table
in right lateral recumbency under lumbosacral epidural analgesia. The left hind limb is pulled dorsally and cranially, and tied to the
table. Post-scrotal region from the level of caudal border of scrotum to the infra-anal area is prepared for aseptic surgery. A 2 cm
long skin incision is given on midline about one inch posterior to the scrotum. Penis is exposed by dissecting subcutaneous fascia and
muscles, and exteriorised by gentle traction so as to straighten the sigmoid flexure. Penis is palpated for the presence of any calculus
in urethra and adequate length of incision is given over the calculus. The calculus is removed through the incision and a sterilize PVC
catheter of appropriate size is passed through the incision in urethra first caudally as far as possible and then cranially so that it
comes out through the preputial orifice. Urethral incision or rupture is closed by PGA No. 5/0 in single layer of simple continuous
suture pattern. Subcutaneous musculature and fascia are closed with catgut No. 3/0. Skin is then closed in horizontal mattress
pattern using surgical silk or nylon thread No. 1.
Urethrostomy
Permanent ischial urethrostomy helps in eliminating the most commonly affected segment of urethral tract, and thus prevents
the recurrence. The goat is restrained in dorsal or lateral recumbency. Sacrococcygeal or lumbosacral epidural anaesthesia or local
infiltration with 2 per cent lignocaine can be administered. The perineal area extending from the anus to the scrotum is clipped and
prepared for the surgery. Skin incision of about 4 cm is made about 2 cm proximal to the caudal border of the scrotum. Adequate
blunt dissection is necessary to allow the penis to be exteriorized without excessive tension. To avoid placing the urethrostomy in
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tissues likely damaged by sharp calculi, the site chosen for urethrostomy should lie proximal to the distal bend of the sigmoid flexure.
In cases of urethral rupture, it may be advantageous to transect the penis distal to the urethrostomy site; this will facilitate drainage
of urine from the tissues of the inguinal region and prevent infection in devitalized tissue. The dorsal penile vessels are ligated imme-
diately proximal to the transection site. The penis is transected and the distal segment excised, a horizontal wedge resection of the
cavernosum of the stump is performed, and the cavernosum is closed to limit haemorrhage. The penis is then re-positioned so that
the stump is located at the distal apex of the skin incision. If the distal penis is not to be excised, the dorsal penile vessels are left
intact.
To hold the exteriorized segment of penis in place, a horizontal mattress suture of monofilament, non-absorbable material is
placed through the skin and into the tunica albuginea of the penis on each side of the distal apex of the skin incision. Alternatively,
the tunica albuginea can be secured with absorbable suture to the subcutis of the apex of the distal incision. The urethra is incised in
a vertical length of approximately 3-4 cm. With proper positioning of the penis, the urethral incision should lie immediately adjacent to
the skin incision. If the skin incision is judged to be of excessive length, it can be closed to create a skin incision that more closely
aligns with the edges of the incised urethra. A 0 to 3-0 monofilament, nonabsorbable suture material is used to appose the edges of
the urethral mucosa to the adjacent skin edges, thus creating a spatulated urethral orifice. The dorsal and ventral apices of the
urethral incision are sutured to the corresponding apices of the skin incision. A simple interrupted pattern or several small sections of
simple continuous pattern are used to complete the suturing of urethral mucosa to the skin. Meticulous apposition of the urethral
mucosa to the skin is necessary to limit haemorrhage from the corpus spongiosum, prevent urine leakage into the subcutis, and
create a permanent stoma.
Tube Cystostomy
Tube cystostomy is a urinary diversion or urethral bypass technique, in which a Foley’s catheter is placed into the urinary
bladder lumen via a small skin incision. It has been used in the treatment of urethral obstruction, urethral rupture or ruptured urinary
bladder in small ruminants. Urine diversion by Foley’s catheter can be done either temporarily in urethral repair/acute urethral
obstruction or permanently in bladder cancer or neurogenic bladder atony. Tube cystostomy catheter also provides avenue for
normograde contrast cysto-urethrography, which may be beneficial for evaluating the extent of urethral obstruction or urethral
integrity post-operatively and therefore, may potentially be used to monitor urethral healing, assess medical therapy for calculi
dissolution and determine when the animal should be encouraged to micturate through the urethra by occluding the drainage
catheter. The technique can be utilized effectively in the cases of urethral or bladder ruptures in calves and goats. The animal is
restrained under lumbosacral epidural analgesia as for cystotomy. Left ventral abdominal area from the level of umbilicus to the
scrotum is prepared for aseptic surgery. A 2 cm long paramedian incision is given 5 cm lateral to midline and 2-3 cm cranial to
rudimentary teats in prepubic region, so as to facilitate approach to the urinary bladder. A straight artery forceps is passed anteriorly
from the incision to a distance of about 15 cm making subcutaneous tunnel, the tip of the artery forceps is brought out of the skin
near preputial orifice by making another nick incision. A tract is thus formed for the fixation of Foley’s catheter. A No. 14 French
Foley’s catheter is pulled through the tract with the help of the same artery forceps. Rectus abdominis muscle and its sheath are
separated using pointed end scissors. The abdominal viscera are reflected aside, urinary bladder is palpated and is held in position
with two fingers. Foley’s catheter is anchored to a K-wire by its eye and passed into the urinary bladder (just behind vertex in
ventral midline) with a sudden thrust applied to the K-wire without exposing the abdominal organs. As soon as the urine starts
coming out from the catheter, the balloon of Foley’s catheter is inflated with 5 ml of sterile saline, the K-wire is retracted slowly and
then 10 ml of saline is infused into the balloon of the catheter. A purse string suture using a monofilament absorbable suture of 1/0-
size is placed in the bladder wall to secure the catheter in place and prevent urine leakage. Care is taken to avoid puncturing of the
catheter or its balloon during suture placement. The external end of the catheter is then pulled gently to appose the bladder wall to
the body wall at the interior aspect of the incision. The abdominal muscle layer is sutured with No.1 catgut and skin with No.1 silk or
nylon. The part of Foley’s catheter outside the abdomen is fixed with abdominal wall using 5-6 stay sutures.
Ammonium chloride 500 mg/kg body wt. is given as acidifier to the animals from day 3 of surgery. Urethra is examined for the
reestablishment of patency by examining the signs of urination, and if possible by positive contrast cysto-urethrography. Treatment is
continued for at least 15 days so as to maintain urine pH within a range of 6.0-6.5. Clamping of Foley’s catheter is started from day
5 to encourage urination through prepuce and animal is examined for the signs of urination. Cystotomy catheter is blocked when the
urethral passage is clear of obstruction. Foley’s catheter is removed by deflating its balloon and is pulled out of bladder and abdomen
3-4 days after clearance of urethral passage. The tract left by catheter is dressed until healing, which takes place without any
complications.
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Figure 17.1: Tube Cystostomy in a Goat.
Cystorrhaphy
The most serious sequel to ever increasing pressure of accumulating urine in an untreated case of urethral obstruction is the
rupture of urinary bladder. The use of drugs like Frusemide to treat the urethral obstruction in field conditions further aggravates the
chances of bladder rupture by increasing the urine production. Repair of the ruptured urinary bladder is the clinical situation requiring
cystorrhaphy, whereas cystotomy is indicated to clear the bladder of calculi with and without urohydropropulsion. Lumbosacral
epidural anaesthesia is generally adequate, however, infiltration of the abdominal wall with lignocaine is also required at times.
The animal is restrained on the table in right lateral or dorsal recumbency, and the left hind limb is lifted and tied to the far side
of the table to expose the caudal ventral abdomen. Left ventral abdominal area from the level of umbilicus to the scrotum is
prepared for aseptic surgery. A paramedian skin incision, 2-3 cm lateral to the prepuce, measuring about 10 cm is made. The caudal
end of the incision is extended up to the level of the rudimentary teats. The subcutis is incised to expose the external rectus sheath.
The incision is continued through the rectus abdominis muscle and the peritoneum is incised to open the abdominal cavity. In cases
of rupture of urinary bladder the accumulated urine in abdomen is drained slowly so as to avoid shock. The urinary bladder is located
and pulled out through the abdominal incision by gentle traction. Rent in the bladder is identified and closed by continuous Lambert
sutures reinforced by Cushing sutures using 3/0 polyglycolic acid. Urinary bladder is examined for any leakage by applying gentle
pressure. Abdominal cavity is lavaged with normal saline solution and then closed routinely by suturing muscle and peritoneal layers
together with 1/0 chromic catgut by simple continuous pattern. Subcutaneous layer may be sutured with absorbable suture of 2/0 size
in continuous pattern. Skin is closed by 1/0 surgical silk or nylon by horizontal mattress sutures.
Figure 17.2: Tube Cystostomy after Cystorrhaphy.
Surgical Managements of Urolithiasis in Bullocks

The most common site of obstruction in cattle is distal part of sigmoid flexure adjacent to the attachment of the retractor penis
muscle, but calculus can get lodged anywhere between the ischial arch and the sigmoid flexure, and in a few cases at the neck of
the urinary bladder, or even the tip of urethra.
Obstruction to the flow of urine can lead to futile and painful attempts by the animal to void urine. The clinical signs of retained
urine become apparent within 24 hr after complete urethral obstruction, and rupture of the bladder occurs within 72 hr and the
animal gets temporary relief. If proper treatment is delayed further, the animal may die in 4-5 days, but some animals may survive
longer. Since sigmoid flexure is the most common site, post-scrotal urethrotomy is generally performed for the removal of the
calculus, however, when the calculus is lodged at other sites, the urethrotomy incision needs to be made accordingly.
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Post-Scrotal Urethrotomy
In cases where the urinary bladder is intact, post-scrotal urethrotomy alone may relieve the obstruction. The animal is
restrained in right lateral recumbency and the midline area extending from the scrotum to the infra-anal arch is prepared for surgery.
Local anaesthesia is achieved using line infiltration technique; caudal epidural analgesia is discouraged as it may reduce the tonicity
of the bladder. A 10-15 cm long midline incision is made extending upward from the caudal border of scrotum. The skin and
subcutaneous tissue are incised, the muscles dissected bluntly; haemorrhage is generally minimal in this area. The penis in this area
can be felt as a hard cord like structure. A curved artery forceps is passed under the penis and it is levered. A gentle incision may
be given over the penis to remove the fascial covering around the penis, while avoiding cutting the penile veins. Sigmoid flexure is
straightened and an adequate length of the penis is exteriorized. The urethra lies in the urethral groove on the ventral aspect of the
penis. It passes between the insertions of the retractor penis muscle. The urethra is thoroughly examined by holding the penis in
palm and palpating the urethra by passing the thumb over it. In bullocks the obstructing calculus can be felt as a hard and irregular
bulging in the passage of urethra. A nick incision is given on the urethra at the site of the uroliths which is then pressed out or
removed by holding it with the help of a small artery forceps. When the calculus is located above the sigmoid flexure towards the
ischial arch, it can be palpated in many cases by passing the index finger along the penis. The incision is extended up to the level of
calculus lodgement.
After removing the calculus, a snugly fitting sterilize polyethylene catheter is passed into the urethra, first to the proximal end as
far as possible, as many times it is not possible to pass the catheter up to the bladder from this incision. The other end of the catheter
is passed from the same incision to distal urethra so that it comes out through the preputial orifice. Flow of urine through the catheter
indicates correct placement of the catheter and clearing of the obstruction. The outer end of the catheter is anchored with the
preputial sheath to prevent its dislodgement. Some workers do not advise suturing of urethral wound, because if catheter is snugly
fitted and there is no seepage of urine from the urethral wound, it heals automatically. However, it is recommended to suture the
urethra by simple continuous pattern using an absorbable suture material. Muscles are not sutured. Subcutaneous tissue is closed
with interrupted sutures using absorbable suture material and the skin with mattress sutures using nonabsorbable material like nylon
2-0. The catheter is allowed to stay in the urethra up to 20 days.
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Figure 17.3: Placement of PVC Catheter in Urethra after Removal of Calculi.
Cystorrhaphy
Rupture of the urinary bladder is very common in bullocks after urethral obstruction. Delayed diagnosis of the obstructive
urolithiasis and delayed presentation of the case to the clinics frequently result in rupture of the urinary bladder and development of
“water belly” condition. It is reported that discrete dorsal tears may sometimes heal spontaneously and ventral tears require surgical
intervention; however, once the abdomen is opened to locate the site of obstruction, it is advisable to carry out cystorrhaphy. The
repair of the urinary bladder is preferably undertaken after removal of the calculus from the urethra because normograde urethral
catheterization can be performed at the time of cystorrhaphy.
Cystorrhaphy can be undertaken through different approaches like para-anal, infra-anal and ventral; however, left paralumbar
fossa approach is preferred as it provides sufficient space for manipulation of bladder in standing animal. The surgery can be done
under paravertebral or local infiltration analgesia. After achieving local anaesthesia and preparation of the site for surgery, about 20
cm long skin incision is made in the most caudal part of paralumbar fossa. The abdominal fascia, muscles and the peritoneum are
incised to enter the abdominal cavity. The laparotomy incision should be large enough to allow the entry of both hands into the
abdominal cavity. The urine present in the abdomen will gush out and the urine below the level of incision should be siphoned out as
much as possible. The urinary bladder is identified and the tear in the urinary bladder is located and the bladder is examined for the
presence of any calculus, concretions or blood clots, which are removed before undertaking the repair. Catheterization of the urethra
is attempted with a polyethylene catheter having a sterile stylet. The proximal end of the catheter is fenestrated before attempting
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catheterization. The catheter is passed inside the bladder through the tear and introduced into the urethra up to the entire length of
the urethra. The stylet is then pulled out from the proximal end. The catheter is held from the distal end and pulled slowly so that
only 2-3 cm of the catheter remains in the urinary bladder. The distal end of the catheter is anchored to the preputial sheath using a
non-absorbable suture.
The tear in the bladder ideally should be repaired by applying inverting sutures but may be repaired by applying continuous
sutures using absorbable suture material. A second row of continuous suture is applied to avoid leakage. The abdominal cavity is
copiously lavaged with saline to remove the traces of the urine before closing the abdominal incision in a routine manner.
Tube Cystostomy in Bullocks

Tube cystostomy has produced excellent results in the management of urolithiasis in small ruminants and dogs. Urethrotomy
can be avoided in many cases with the use of this technique. The original technique through the flank or ventral abdomen can not be
applied in large animals due to the smaller length of Foley’s catheter. The technique of tube cystostomy is, therefore performed
through para-anal approach in bullocks.
Figure 17.4: Tube Cystostomy in Bullocks through Para-Anal Approach.

A left flank laparotomy is performed in the bullock under paravertebral block and the urine in abdominal cavity is siphoned out.
Under caudal epidural analgesia a nick incision is made in perianal fossa lateral to anal opening. An intramedullary pin of 10 mm
diameter is used to make a rent in the pelvic diaphragm. A Foley’s catheter is then introduced through this tunnel in the pelvic cavity
with the help of a 5 mm orthopaedic K-wire. The Foley’s catheter is fixed into the bladder on the lateral side near the apex by
inserting the hand through the laparotomy incision. The balloon of the catheter is inflated and laparotomy incision closed. The
approach is suitable for large animals and can be used to facilitate the healing of urethrotomy incision by providing urinary bypass.
18
Castration of Male Animals
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M.R. Fazili
Castration is one of the most frequently performed surgical procedures in veterinary practice. Castration as far back as 7000
BC has been the only early surgery performed in cattle. The common indications of castration are to make the animal docile, for
easy management in the presence of female animals, to prevent unwanted animals from breeding, malignant disease or irreparable
injury of the testes, to promote weight gain in meat animals, and for correction of scrotal hernia.
Younger animals are generally easier to restrain, have lesser risk of incisional complications and show decreased aggressive
behaviour after castration. Bulls castrated prior to puberty grow to a greater height because castration delays closure of the growth
plates of their long bones, and the same may be true in other animal species. The preferable ages of castration in cattle (1-2
months), sheep and goats (2-3 weeks) and horse (1-1.5 yrs) have been reported. But in actual practice, the animals may be
castrated at any age. Under field conditions, the owner’s choice, ease of procedure and intended use of the animal may affect this
decision. Whenever possible the extreme climates and the heavy fly seasons should be avoided.
Adequate fasting of the animal preoperatively in all elective surgeries is an important prerequisite for successful outcome. The
surgeon should ensure that the correct animal is castrated and obtain a medical history. A brief physical examination to determine
the health status is always recommended. The scrotum is examined to confirm the presence of both testes and to determine whether
inguinal herniation is present or not. Under field conditions most clinically normal animals can be safely subjected to routine elective
surgery without the benefit of laboratory tests. However, the procedure should not be performed on sick animals. The surgeon
should wear sterile gloves for all open surgeries and use sterilized instruments. Perioperative antibiotics are also necessary
particularly under field conditions.
All techniques of castration in animals have several principles in common: adequate restraint, safety, good anaesthesia, clean
surgery, control of haemorrhage, and adequate post-operative drainage. The various popular techniques of castration in male animals
could be divided into the following categories:
Ruminants (Cattle, Sheep, Goat)

1) Closed(Bloodless techniques):
a) Emasculatome- Burdizzo
b) Elastic banding, Elastrator, EZE bander, Calicrate bander
2) Open techniques:
a) Short scrotum method (not sutured)
b) Newberry knife technique (not sutured)
c) Unilateral orchiectomy (for unilateral disorders)
Equine and Small Animals

1) Open Method– Orchiectomy
a) Open uncovered or “Open Open” method
b) Open covered or “Open Closed” method
Quiet stallions those allow palpation of the scrotum and testes with little resentment and without sedation are the best
candidates for standing surgery. Typically older calves may be put into a squeeze chute or stocks for bloodless castration. Most of
the remaining animal species are castrated in recumbency. Ponies, donkeys, mules and horses with poorly developed testes are also
difficult to castrate in standing. Lambs and small goats are held head down, between the operator’s knees or head up with the front
and hind limbs on each side held together. Calves younger than one month of age are usually restrained in lateral recumbency.
Traditionally analgesics and anaesthetics have not been used for castrating ruminants by closed methods. But several studies
conducted in the recent past show increased cortisol level in addition to the typical distress behaviours in animals subjected to
castration. Analgesia/anaesthesia should therefore be achieved in all the ruminants of all the ages undergoing castration. Sedation
along with local infiltration analgesia (scrotal skin/spermatic cord) should be used in every animal. To avoid local anaesthetic toxicity
in small ruminants, the 2 per cent lignocaine hydrochloride should be diluted to 0.5 per cent or 1.0 per cent before use. Xylazine at
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0.02-0.1 mg/kg IV or 0.04-0.2 mg/kg IM gives satisfactory sedation. Lower range may be used for goats, debilitated, aged, young or
depressed animals. In goats midazolam (0.1-0.2 mg/kg IV) in combination with butorphanol (0.02 mg/kg IV) may be used
alternatively. In small animals, several injectable anaesthetic combination protocols (phenothiazine derivatives, benzodiazepines,
alpha-2 agonists, opioids, dissociative anaesthetics and ultrashort acting barbiturates) for conducting elective surgeries in dogs have
been standardized. Ketamine (5-10 mg/ kg) with xylazine (1-2 mg/kg) or diazepam (0.1-0.2 mg/kg) along with atropine (0.02-0.04
mg/kg) premedication is currently the easily available and comparatively economical mixture most frequently used in field settings.
For standing castration in equines, sedation with xylazine or a combination of xylazine with butorphanol is recommended. Local
anaesthesia is achieved by using an 18-gauge, 1.5 inch needle that is fully inserted into the center of the testis and 10-15 ml of
lignocaine hydrochloride instilled. The needle is withdrawn so that the tip is in a subcutaneous location, and 10 ml of anaesthetic is
instilled on a line 1 cm from the median raphe from the cranial to caudal pole of the testis. The second testis is anaesthetized in the
same manner. After anaesthetic infiltration, the surgeon should wait for 5 minutes for diffusion of the drug proximally into the
spermatic cord. Many surgeons prefer to castrate horses using short-acting intravenous anaesthetics. A clean safe area to
anaesthetize and recover the horse must be located. The horse is sedated with xylazine hydrochloride at 0.5-0.8 mg/kg IV.
Ketamine hydrochloride 2.2 mg/ kg and butorphanol tartrate 0.044 mg/kg are combined and given IV 5 minutes after xylazine
administration. Duration of action of the anaesthetic combination is usually 10-15 minutes. If necessary, anaesthesia can be extended
by administering half the dosage of xylazine and ketamine combined in one syringe.
Burdizzoo Castration
This is the most popular technique of castration in ruminants. In this technique, the spermatic cords with the blood vessels
leading to the testicles are crushed. One spermatic cord is clipped at a time and the two cords are clipped at different levels. Gradual
atrophy of the testicles is noticed subsequently. Advantages of the technique are bloodless technique, less chances of infection (no
open wounds), no risk of maggot infestation, less pain than cutting, and quickly and easily accomplished. Disadvantages include
chances of injury to the animal and mistakes while clamping (penile trauma, crush site of the two sides meeting together arresting
the blood supply to the scrotum thus resulting in gangrene and infection, slip of the cord from the crush or cord incompletely
crushed).
Figure 18.1: Burdizzo Castration Sites.

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Figure 18.2: Castration of Cattle with Burdizzo Castrator.
Figure 18.3: Burdizzo Castration in a Buck.
Elastrator
Castration is performed routinely in lambs during the first week after birth by applying tight rubber rings to the neck of the
scrotum so that both testicles are below and two teats above the ring. Sloughing of the scrotum along with the testes distal to the ring
generally takes three weeks time.
Figure 18.4: Elastrator Tool Used to Apply Rubber Rings.

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Figure 18.5: Elastic Band at Top of Testicles.
Figure 18.6: Lamb Castration with Elastrator.
Unilateral Orchiectomy
Valuable ruminants with nonheritable unilateral disorders other than herniation (hydrocele, haematocele, testicular tumour,
epididymitis, abscess, varicocele) are subjected to unilateral orchiectomy. Vertical incision is made on the lateral aspect of the
affected side of the scrotum approximately the entire length of the testis. Vaginal tunic is incised over the length of the testis.
Spermatic cord is isolated, double ligated and transected or emasculated. The transected tunic is over sewn with an absorbable
suture material. Excess scrotal skin is removed to reduce the dead space and prevent post-operative seroma formation. Scrotal
fascia and skin are closed routinely.
In equines the castration technique involves orchiectomy, regardless of whether the horse is castrated while standing or
recumbent. Scrotal incisions are given over each testis from cranial to caudal pole 1 cm parallel and away from the median raphe.
The open technique of castration is probably the most commonly used technique. In this technique, the parietal (or common vaginal)
tunic is retained. With the closed and the half-closed techniques, the portion of the parietal tunic that surrounds the testis and distal
portion of the spermatic cord are removed. Routine castration is performed with an emasculator. The instrument crushes the
spermatic cord to control haemorrhage, and severs the cord distal to the crushed area. For each technique, the emasculator is
applied at a right angle to the spermatic cord, loosely closed to avoid incorporation of scrotal skin, and slid further proximally. The
emasculator is applied in such a way that the crushing component is proximal to the cutting blade. When correctly applied, the wing-
nut of the emasculator is oriented distally toward the testis, and the emasculator is positioned “nut to nut.” Under field conditions the
emasculotome is generally not available. The spermatic cord/vasculature can be carefully ligated using sterile nonabsorbable No.2
braided silk suture by transfixation proximal to the site of resection. By convention, scrotal incisions are usually left unsutured to heal
by secondary intention. Primary closure, however, speeds up healing, and recovery eliminates infection and decreases oedema, pain
and muscular stiffness. Primary closure may be particularly useful if vigorous exercise cannot be enforced post-operatively. Primary
closure decreases convalescence but is time consuming and requires meticulous haemostasis and strict adherence to aseptic
technique. All horses and small ruminants not previously immunized with tetanus toxoid are immunized. The animal’s activity is
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restricted for the first 24 hr after castration to avoid haemorrhage from the severed testicular and scrotal vessels. After this period,
they are exercised to the degree necessary to prevent excessive preputial and scrotal oedema.
Figure 18.7: Open Castration of a Horse Performed in the Field Under a General Anaesthetic.
Figure 18.8: Use of Emasculotome during Equine Castration.

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Figure 18.9: Testicle Pushed towards Pre-Scrotal before Castation
Figure 18.10: Canine Castration in Progress.

In the dog a median skin incision is made cranial to the scrotum and is carefully extended through the subcutaneous tissue
layers. This incision should extend from the base of the scrotum a sufficient length cranially to allow expression of each testis
through it. In dogs under 35 kg body weight, a closed castration technique is preferred. Large and giant breeds are castrated by the
open method. In these animals, the testicular artery and vein, and the ductus deferens are collectively ligated with a suture proximal
to the pampiniform plexus. The skin is carefully closed with a fine nonabsorbable suture material in an intracuticular or a simple
interrupted pattern.
Pinhole Castration
Pinhole castration, an alternative simple, economical, quick, requiring no special instruments and field applicable technique, has
recently been described in ruminants and stray dogs. Under sedation and local anaesthetic infiltration, in situ spermatic cord ligation
is achieved by restraining the cord laterally within the scrotal sac and passing catgut No. 1 through a hypodermic needle inserted
caudal to cranial at the neck of the scrotum and adjacent to the medial margin of the restrained spermatic cord. The needle is
removed leaving the suture in place and the spermatic cord repositioned medially. Then the needle is reinserted through the original
holes, and the suture passed back through the needle. The hypodermic needle is subsequently withdrawn. The suture ends are tied to
ligate the spermatic cord, leaving the square knot subcutaneously. Instead of the hypodermic needle, traumatic suture needle of a
larger size or sterile silk may be used. The technique has high potential of managing large volume of stray dogs, monkeys and ponies
in developing countries where the governments and the public may not afford comparatively expensive orchiectomy, the
conventional procedure of castration. Strict asepsis and requirement of analgesics for 3 or more days following pinhole castration are
the main disadvantages.
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Figure 18.11: Pinhole Castration.

19
Ovariohysterectomy in Canines and Felines
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A.K. Gangwar and Kh. Sangeeta Devi
Ovariohysterectomy is the surgical removal of the uterus and ovaries. It is a major surgical procedure which requires general
anaesthesia, full theatre discipline and surgical technique. The uterus is an organ which comprises of a uterine body, two horns (to
which the ovaries are attached) and a cervix. Strictly speaking the spaying of an animal means the removal of the ovaries
(ovariectomy). When both ovaries and the uterus to the level of the cervix are removed this operation is known as an
ovariohysterectomy.
Ovariohysterectomy is usually performed during anestrus, since reproductive and mammary tissues are more vascular under
the influence of estrogen. Additionally, the uterus is more friable during estrus and may tear when crushed by clamps.
Indications
Elective sterilization: Most common indication for ovariohysterectomy.
Heat prevention: To prevent estrus and the associated problems such as bloody vaginal discharge, the nuisance of male
dogs being attracted and unwanted pregnancies.
Treatment of ovarian and uterine diseases : Ovariohysterectomy is indicated for the surgical treatment of ovarian cysts,
pyometra, uterine torsion, uterine prolapse, uterine intussusceptions, uterine neoplasia and uterine rupture.
Mammary tumour reduction: Spaying at an early age/before the first ovarian cycle reduces the risk and severity of
mammary cancers. It is important to be aware that 50 per cent of mammary tumours are malignant in the entire (un-
neutered) bitch.
Pyometra prevention: Pyometra is an infection whereby the uterus fills with pus and the dog’s condition deteriorates
rapidly. It is a very serious condition, more commonly seen in the middle-aged and elderly bitch. Ovariohysterectomy is
indicated as the treatment or prevention of pyometra.
Phantom pregnancy prevention : Ovariohysterectomy is also indicated as a permanent treatment for recurrent and
severe false pregnancy, phantom pregnancy or pseudocyesis. Phantom pregnancy may cause behavioural changes (e.g.
depression, nest making) as well as physical changes (lactation, abdominal enlargement etc).
To prevent recurrence of vaginal hyperplasia.
To prevent hormonal changes that can interfere with medication in diabetic or epileptic dogs or cats.
Surgical Anatomy
The ovaries are located ventral to the 4th lumbar vertebra and close to the caudal pole of the corresponding kidney.
The ovary is completely enclosed by the bursa, except when it is enlarged by the ripe follicles at estrus.
The ovary is attached to the cranial end of the uterine horn by the ovarian ligament, which is continuous with suspensory
ligament of the ovary. The suspensory ligament is attached to the transverse fascia near the vertebral end of the last rib
and offers the main resistance to withdrawal of the ovary from the abdomen.
The blood supply to the ovary is through ovarian artery and vein. The artery leaves the aorta at 4th lumbar vertebra,
crosses the caudal pole of the kidney and enters the dorsal curvature of the ovary.
The uterus has two very long and narrow horns and a short body. The horns diverge from the body in the form of a ‘V’
towards each kidney.
Broad ligament is attached to the anterior part of the vagina.
Uterine artery originates from the urogenital artery and enters the caudal part of the broad ligament at the plane of the
cervix and lies close to the caudal part of the uterus.
Surgical Procedure
Anaesthesia and Positioning of Animal
In field conditions the best anaesthetic combination is atropine-xylazine-ketamine (0.04 mg/kg, i.m. – 2 mg/kg, i.m. – 10 mg/kg,
i.m.). Each drug should be given at an interval of 5 minutes. The animal can be maintained by giving extra dose of ketamine
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intravenously or diazepam @ 0.25 mg/kg, i.v. The animal is positioned in dorsal recumbency (midline approach) or right lateral
recumbency (flank approach).
Aseptic Preparation of the Site

Mid-ventral area from the xephoid to pubis or lateral flank area is shaved and scrubbed with antiseptic solution. Finally betadine
is painted at the site.
Approaches
The uterus and ovaries can be approached through one of the following techniques.
1. Midline incision approach
2. Flank incision approach
3. Laparoscopic technique
1. Midline Incision Approach

The length of the midline abdominal incision is based on the species and size of the animal.
The distance between the umbilicus and the pubis is divided into cranial, middle and caudal third.
In dog, the incision is made in the cranial third because the ovaries are more difficult to exteriorize than the uterine body.
In cat, the incision is made in the middle third because the uterine body is more difficult to exteriorize than the ovaries.
The incision is made through the three layers to expose the abdominal contents (skin fascia- outer skin, linea alba-outer
layer of muscle under the skin and peritoneum- inner muscle layer).
The uterine horn is located by means of an ovariohysterectomy hook or the index finger.
Apply a clamp on the proper ligament. The clamp is used to retract the ovary while the suspensory ligament is stretched
or broken with the index finger.
Make a window in the mesovarium caudal to the ovarian vessels. Three clamps are applied at the ovarian pedicle and the
pedicle is severed between the clamp closest to the ovary and the middle clamp.
The clamp applied distally from the ovary, is removed so that the pedicle ligature can be placed in its groove.
The pedicle is ligated by chromic catgut.
The pedicle is inspected for bleeding and gently replaced into the abdomen.
Same procedure is repeated on the opposite ovarian pedicle.
The blood vessels in the broad ligament can be ligated before severed or torn.
Three clamps are placed on the uterine body just cranial to the cervix. The uterine body is severed between the proximal
and middle clamps.
The uterine arteries are individually ligated caudal to the most caudal clamp.
Remove the caudal clamp and the uterus is ligated in the groove that remains.
The pedicle is inspected for bleeding and gently replaced into the abdomen.
At the end of surgery the abdominal incision is stitched up routinely in three layers. The outer layer of stitches on the skin
fascia, if non-absorbable material is used, should be removed 10 days post-surgery.
Immediate post-operative treatment generally includes pain relief, broad spectrum antibiotic, antiseptic dressing of the
wound, exercise restriction and recovery diet. An Elizabethan collar is often given to prevent the dog from licking at the
wound. Long term dietary modifications are often indicated to prevent obesity, which often occurs after spaying due to
alteration in hormone levels.
Advantages
Large ovarian tumours, and pyometra is best treated by this site
Disadvantages
Incision size is large
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Chances of wound contamination, wound dehiscence and incisional hernia are more
Wound healing is slow
Figure 19.1: Mid Ventral Approach.
Figure 19.2: Ovariohysterectomy by Mid Ventral Approach.
Figure 19.3: Flank Approach.

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Figure 19.4: Ovariohysterectomy by Flank Approach.
2. Flank Approach
Ovariohysterectomy through a single incision in the left flank is particularly useful in cats. However, right flank approach
is preferred in bitches.
The incision is usually located midway between the cranial aspect of the tuber coxae and the caudal most aspect of the
last rib.
The incision is usually made in a transverse plane and ranges from 2-8 cm in length. In bitches, obliquely downward and
backward incision is made. After dissection through subcutaneous fat, a grid incision which involves blunt separation
along the direction of the muscle fibers through the three muscular layers (abdominal external oblique, abdominal internal
oblique, transversus abdominis) is made.
Branches of the deep circumflex artery may be encountered with the transverse abdominal muscle layer and may require
ligation. Alternatively, the layers may all be incised in a transverse plane instead of a grid.
Advantages
Incision size is small
Chances of wound contamination, wound dehiscence and incisional hernia are less
Wound healing is fast
Disadvantages
Large ovarian tumours and pyometra can not be treated by this site.
Complications
Haemorrhage
Ovarian remnant syndrome: due to the remnant of ovarian cells
Uterine stump pyometra
Inflammation and granuloma
Fistulous tracks
Ligation of ureter: accidental ligation of the ureter causing hydronephrosis or atrophy of the kidney
Urinary incontinence
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20
Caesarean Section
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Rekha Pathak
Caesarean section is also commonly termed as C-section in which the uterus is exteriorized to take out the foetus from the
pregnant dam.
Indications
Uterine inertia
Various types of obstructive dystocia ( e.g., emphysematous foetus, oversized foetus, small pelvic canal and pelvic
fractures of the dam, and position and posture dystocia)
Rupture of uterus (may be due to excessive manipulation of the foetus)
Animal in highly compromised condition like pregnancy toxemia, weak prostrated dam unable to show labor etc.
In the mares twin pregnancy is a common indication for C-section
Uterine torsion
Incomplete cervical dilatation
It is important to choose a clean and bright place for the operation. The air borne contamination should be strictly avoided and
utmost care should be taken to prevent the post-operative complications and septicemia because the successful outcome of the
operation is mainly dependent on the strict asepsis which is followed.
Site of the surgical operation varies with the type of species. In dogs the site is ventral line incision behind the umbilicus; in the
cow a vertical or oblique incision on the left lower flank is preferred (for the reason that on the left side the intestinal interference is
least) (Figure 20.1). In mares, a left paramedian incision (caudal) or ventral midline incision is preferred. In small ruminants like
goats and ewes, the sites chosen are just as in cattle. For left lower flank incisions, the animals are put on the right lateral
recumbency, and for ventral midline incision they are put on the dorsal recumbency. It is important to comfortably cast the animal at
an optimal height so that the surgeon is not only comfortable of his posture but since this operation takes relatively longer time and
cumbersome, especially in large animals. There should be a skilled team consisting of at least two surgeons at the operative site and
one assistant on the instrument table. Two skilled assistants should take care of the intravenous fluid administration and other drugs
requirement of the casted animal. The animal should be first checked for dehydration and every attempt should be made for
stabilizing the animal with administration of intravenous fluids and other life saving drugs like corticosteroids.
Figure 20.1: Left Lower Flank Incision in Cattle.
Surgical Anatomy
Dog
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The gravid uterus has dilated horns in the shape of ‘Y’, which contains the foetuses and lies on the ventral abdominal floor
extending up to the level of stomach towards the end of gestation.
Cow
The gravid uterus may lie directly up on the right abdominal floor or within the supraomental space with the intestine concealed
on the right by superficial and deep parts of greaten omentum.
After giving an incision at the left lower flank, the uterus is usually brought outside by feeling and grasping the foetal parts. The
uterus may be exposed for caesarean section by simply drawing the greater omentum forward. If the foetus in mummified, instead
of giving a lower flank incision, upper flank incision is usually preferred; whereas in full term gestation because the uterus due to its
weight is found on the ventral floor of the abdomen, it is better to go for the lower flank incision.
Anaesthesia
In dogs where the pups are found to be alive by ultrasonographic or Doppler examination, thiopental or xylazine is avoided for
the reason of respiratory depression of pups, and a combination of epidural and local infiltration with 2 per cent Lignocaine can be
given.
A combination of diazepam and ketamine can also be given intravenously at the dose rate of 0.5 mg/kg body weight and 5.0
mg/kg body weight, respectively. In cattle or buffalo, slight sedation may be needed sometimes along with local infiltration at the line
of incision. In mares, inhalation anaesthesia with inhalant anaesthetic agents is preferred.
Surgical Technique
Midline incision behind the umbilicus includes incision on the ventral aponeurosis of the muscles (white line). The ventrolateral
oblique incision is usually used in cows and buffaloes with the animals controlled in lateral recumbency and hind limbs extended
caudally. Incision is made just in front of stifle extending cranioventrally in a slight oblique direction. The structures invaded are skin,
subcutaneous fascia and combined aponeurosis of the two oblique muscles, which form the external sheath of the rectus abdominis,
transverse abdominis and peritoneum. Paramedian incision is preferred in mares and the structures include skin, fascia, external
rectus sheath, rectus abdominis muscle, internal rectus sheath and peritoneum.
Dogs can be premedicated with atropine sulfate @ 0.04 mg/kg body wt subcutaneously, followed by diazepam @ 0.5 mg/kg
body wt and ketamine @ 2-5 mg/kg body wt. intravenously. This regimen is followed if the foetuses are found administered to be
alive by other examinations. But if there is a certainty that foetuses are dead or infected, then atropine sulphate is followed by
thiopentone sodium @ 8-10 mg/kg body wt. A long incision on the linea-alba is given in medium and small sized dogs to exteriorize
the uterus. But if the animal’s size is more than 25 kg an oblique incision is preferred on the flank or paramedian site to avoid
postoperative dehiscence and hernia.
The cow is controlled in standing or right lateral recumbency and a long skin incision is given by saving the left subcutaneous
abdominal vein. We can either give the local infiltration or epidural anaesthesia with 2 per cent lignocaine. In bitches, the bifurcation
of uterine body is first visualized and an incision is made over it in order to enable the milking (squeezing) of pups from both the
horns. The foetuses are removed along with foetal membranes one by one. The umbilical vessels are ligated and cut, and the new
born foetuses are handed over to a helper or nurse for resuscitation. They are wiped with mops and assisted for artificial respiration
if fail to breathe. The head is lowered to permit drainage of fluids from the upper respiratory tract. In cow the uterine incision should
follow the longitudinal line of greater curvature of the uterus.
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Figure 20.2: Foetus being Taken Out from the Uterus.

Forelimbs or hind limbs are grasped depending upon the presentation and the foetus is taken out from the uterus (Figure 20.2).
The calf should be taken care by the assistants. It should be cleaned, dried, cleared off the mucus from the nostrils. The umbilical
cord is ligated far enough from the navel and cut so that it contracts. Antiseptic solution like povidone iodine or tincture iodine is then
applied over it to prevent any infection.
The removal of after-births or placenta is also important. If it is easily removed by gentle traction it should be removed, and it
should not be pulled with force since chances of caruncular bleeding is strong, which may be fatal to the dam. If such bleeding is
encountered in the dam, oxytocin should be given, which largely shrinks the uterus and stops bleeding. Antibiotics can be instilled into
the uterus as common procedure for all the species before closure. The uterine incision is cleaned with a gauze and closed by a
double row of Lamberts cushing sutures using chromic catgut size 2-0 or 3-0 in bitch and size 2 or 3 in cattle and buffaloes.
Abdominal incisions are sutured in routine manner, closing the peritoneum, muscles and skin, respectively (Figures 20.3 and 20.4).
Utmost care is taken to avoid the spillage of uterine contents into the peritoneal/ abdominal cavity for the successful outcome of
surgery. In case such spillage occurs, the abdominal cavity should be lavaged with sterile normal saline containing non-irritant
antibiotics to counteract the infection, reduce the chances of post-operative adhesions and infection. The uterine torsion in case of
cattle and buffaloes should be then corrected. Administration of 50-60 units of oxytocin hastens the uterine involution. Intravenous
administration of a 5 per cent solution of dextrose or normal saline should be invariably included in the schedule as most deaths occur
due to hypoglyacemia and hypochloraemia.
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Figures 20.3 and 20.4: Closure of Uterine and Abdominal Incisions.
Post-operative Care
The mother and the new born foetus should be returned to clean and comfortable environment. If the haemorrhage is
excessive, pituitrin and calcium gluconate may be given intravenously in bitches. Penicillin or some other antibiotics should be given.
If the condition of the patient is poor, administration of blood or plasma expanders and corticosteroids is considered.
Puppies should be given to the mother as soon as she is ready to take care of them. Similarly the new born calf should also be
allowed to suckle and stand on its legs. It not only provides the nourishment to the puppies but will also stimulate the uterine
contractions thereby reducing any risk of placental retention or endometritis. The skin sutures should be removed in 10-12 days after
surgery or after the healing is complete.
21
Management of Fractures
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Hari Prasad Aithal
Fracture is a break in the continuity of bone. Fractures are common in animals and are caused either by direct trauma like
automobile accidents or by indirect trauma caused while running, jumping or falling from a height. Fracture may also be caused by
violent muscle contractions or by systemic/metabolic diseases like rickets or osteomalacia, wherein the bone becomes weak leading
to fracture.
Based on the communication of fracture site with the environment, it can be classified as simple (closed) fracture or
compound (open) fracture. Based on the extent of fracture line, it can be classified as incomplete or complete fracture. Based on
the direction of fracture line in relation to the longitudinal axis of bone, fracture can be called as transverse, oblique, spiral,
comminuted (more than two bone fragments) or multiple (two or more independent fractures of the same bone). Based on the
location of fracture, it can be classified as diaphyseal, metaphyseal or epiphyseal fracture.
Diagnosis of Fracture
Diagnosis of a bone fracture is relatively easy. The first sign of a fracture is generally a non-weight bearing lameness. The
fracture site shows signs of swelling, and the animal carry the affected leg, though it can move on three legs. Incomplete fractures,
sometimes, are difficult to detect, as they usually cause only mild lameness. Confirmative diagnosis of a fracture can be done by
radiographic examination. Generally both medio-lateral and cranio-caudal or dorso-plantar/dorso-palmar views are indicated. In
recent years digital X-ray has increased the accuracy of diagnosing a fracture. Modern diagnostic methods like digital X-ray, CT
scan, nuclear scintigraphy and MRI are particularly useful, where sometimes a survey radiograph fails to diagnose a fracture.
However, these advanced diagnostic tools are generally beyond the reach of a common veterinary practitioner at the field level.
First Aid
Figure 21.1: Radiograph Showing Comminuted Fracture at the Proximal End of Metatarsus in a Cattle.
First aid and careful handling of the animal before definite fracture fixation is important in veterinary practice. The animal
should not be forced to walk on the broken leg or transported to the hospital without a proper splint, to avoid a relatively simple
fracture becoming a comminuted or compound fracture. The animal must be restricted from moving on three legs to reduce further
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damage to the surrounding soft tissues, blood vessels and nerves. Fractured limb should be stabilized first by applying splint, which
allows the animal to regain control of the leg even though it can not put complete weight on it. In excited animals it may be
necessary to sedate the animal for splinting. A rigid splint (any lightweight, relatively strong, rigid material, such as wood or PVC
pipe split lengthwise) is placed over the layer of cotton role applied over the skin and wrapped with a cotton/elastic bandage. Splint
should not be used directly against the animal’s skin. At least two pieces of wood/PVC tubing must be placed 90º apart (never 180º),
one along the outer surface and the other along the front or the back of the leg. Placing the splint along the inner and outer surface
of the leg is ineffective, as it does not prevent the leg from bending.
Factors to be Considered Before Fracture Fixation

The outcome of a fracture and fracture fixation depends on many factors that vary from case to case. Many animals with
simple fractures recover with rest and proper care. Others with much more serious injuries have to undergo surgical fixation at the
earliest. Early care and fracture fixation to stabilize the bone fragments is essential to minimize fracture complications. Several
factors that should be considered while selecting the technique of fracture management, like, age, body weight and species of the
animal, location and type of fracture, presence or absence of soft tissue and neuromuscular trauma, closed or open fracture
environment, ability of the animal to stand and walk, and behavioural nature of the animal, the facilities available and above all the
experience of the surgeon with a particular technique. The cost of treatment is also a major concern in veterinary practice.
External Fixation Techniques

External fixation refers to immobilization of fractures/other skeletal abnormalities with devices applied externally, without the
use of any invasive technique. Among the external fixation devices, plaster of Paris and modified Thomas splints are widely used.
Figure 21.2: A Horse with Scapular Fracture Treated with Conservative Method.
Plaster Cast
Plaster bandages consist of a cotton bandage that has been impregnated with plaster pf Paris, which hardens after it has been
made wet. It is the most widely used external fixation technique in both small and large animals. Indicated in immobilization of
fractures below the mid-diaphysis of radius or tibia. The animal is restrained under sedation/anaesthesia. The placement of the cast
is facilitated by use of rope restraint. An assistant should help to maintain alignment of the limb during application, being sure to
check the position of the limb in cranio-caudal and latero-medial planes. In large animals, the tension on the limb during casting may
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be achieved by placing wires through holes drilled in the hoof wall and applying tension. The talcum powder may be sprinkled over
the limb and an even layer of cotton is applied around the leg in order to protect bony prominences. Over padding should be avoided
because it may impair immobilization by allowing movement of fracture fragments within the cast. Splints are bandaged in place with
an even pressure. Plaster of Paris bandage is soaked in warm water for a few seconds until air bubbles cease to appear. Plaster
bandage is then removed from the water, squeezed and wrapped over the splints, starting at the fracture site and continuing up and
down including the entire limb except the toe pads in dogs and hooves in large animals. The plaster cast is never stretched or
tightened around the limb. The plaster is moulded by rubbing each section with wet hand before the plaster is set. The thickness of
the cast is usually based on clinical judgement. Casts 4-5 layers thick may be adequate for small animals, 6-8 layers for calves less
than 150 kg body weight, but adult cattle may require 12-16 layers thick casts. Casts used on the hind limbs must be thicker because
of stress concentration by the angulation of the hock. Incorporation of splints (wooden/metal) within the cast (2 rods placed 90º to
each other) will increase the strength of the cast. The plaster is then allowed to dry and harden. Complete drying/hardening of the
cast (attaining full strength) may take 24-72 hrs. Use of a walking bar (‘U’ shaped bar placed under the hoof and incorporated into
the cast) will increase the distribution of loading forces into the cast and away from the distal limb. In open fractures, a window
should be left at the site of wound for drainage and regular dressing.
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Figure 21.3: Technique of Fiberglass Casting.

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Figure 21.4: A Buffalo Calf with Metatarsal Fracture Treated with Fibre Glass Application.
Toes and hooves are inspected several times during the first 24 hr for any swelling, coldness or constriction. If the toe/hoof gets
swollen or gets cold, pressure at the end of the cast should be relieved by removing the cast and the cast may be reapplied after
swelling subsides. Cast may be maintained for up to 3-4 weeks in young dogs, 4-6 weeks in adult dogs and calves. Fractures in adult
cattle may heal within 8-10 weeks, but often require 12-16 weeks for clinical union to occur. Plaster is removed after radiographic
fracture union (bony union with resolution of the fracture line) takes place. Affected limb is massaged to promote circulation after
removal of the cast. Movement is restricted till the limb regains its normal function.
Fiberglass castis a lighter, synthetic alternative to the more traditional plaster cast. It is created by padding the extremity with
cotton or waterproof padding material, followed by wrapping several layers of knitted fiberglass bandages impregnated with a water-
soluble, quick-setting resin. It is lighter and more durable than plaster, so fiberglass has quickly become the preferred type of casting
with many practitioners. Though it is slightly more costly, it is easily available everywhere and can be easily practised in the field
level.
The fiberglass cast has many advantages over a plastic cast. It weighs less and is more comfortable. It is made of water-
activated polyurethane resin combined with bandaging materials, so this material offers greater strength and less time for setting. A
fiberglass cast requires less maintenance than a plaster cast. The fiberglass cast is waterproof. Some of the drawbacks with
fiberglass cast are: it sets quickly, so a less-experienced medical care provider has less time to properly wrap the injured extremity.
Further, the synthetic materials leave less room for swelling, and knitted fiberglass and resin bandages are less moldable than the
plaster cast.
Modified Thomas Splints

Modified Thomas splint is indicated for immobilization of fractures at the distal femur, radius/ulna, distal humerus and
tibia/fibula. The splint can be prepared from aluminum rods or conduit pipes of various sizes. For fore limbs, the length of the bar
should be the distance from the thigh up to the tip of the toe in an extended leg. To prepare the ring, a splint mold is used and the rod
is bent around the splint mold. The use of Thomas splint and cast combination is appropriate for fractures distal to the elbow or stifle
in large animals.
External Skeletal Fixation Techniques

External skeletal fixation (ESF) refers to the stabilization of musculoskeletal injury using percutaneous fixation pins that are
connected outside the body to form a rigid frame or scaffold, spanning the region of instability, e.g. transfixation pinning and casting,
and different linear and circular fixators. This type of fixation is indicated for the management of long bone fractures especially of
tibia and radius, where cast immobilization is not appropriate or does not provide optimal level of fixation (fractures proximal to the
distal radial or tibial physis, with soft tissue injuries and open fractures).
Advantages of ESF include early return to function of the affected limb with excellent mechanical properties, ability to adjust
the frame after bone fixation allowing correction of rotational or angular deformities, avoidance of surgical trauma to the injured
tissue, avoidance of infection associated with buried implants, ease of implant removal after fracture union, provision for
transarticular fixation in the presence of severe soft tissue trauma or severe comminution of the proximal or distal end of the
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affected bone, preservation of joint motion and multiple applications with reusability of components.
Figure 21.5: Application of Modified Thomas Splint in a Dog.
Figure 21.6: Modified Thomas Splint for Fixation of Femoral Fracture in Calves.
Transfixation Pinning and Casting

Transfixation pinning and casting (TPC) may be applied either as a “hanging limb pin cast” or as external skeletal fixator.
Hanging limb pin cast refers to placement of transcortical/transfixation pins through the bone proximal to the injury, followed by
application of a full limb cast. This avoids the slippage of cast, especially in hind limbs. The advantage of using pin-casts for ESF
(where pins are passed both in the proximal and distal bone fragments) compared with hanging limb casts is that the fracture is more
stable and the fracture fragments are not able to move within the pin-cast, and the pin-cast may not need to span adjacent joints in
large animals. These techniques can easily be practised under field conditions with least instrumentation and technical support.
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Figure 21.7: TPC for Fixation of Radial Fracture in an Adult Heavy Animal.
For management of open fractures, daily dressing of the wound may be carried out by leaving a hole in the cast (window cast)
at the site of injury. However, this gives unsatisfactory access to the wound and is uncomfortable to the patient because the swelling
in the limb becomes concentrated at the defect in the cast. Alternatively, metal or acrylic side bars may be used; they must be large
enough to sustain the weight of the animal.
Acrylic and Epoxy-Pin Fixation Systems

This is a novel technique of fixation, where materials like acrylic (eg, polymethyl-methacrylate) and epoxy putty (M-seal) are
used to construct the exernal frame of the fixator. Advantages of this free form fixation includes contouring the connecting bars to
match any fracture configuration, pin direction need not be influenced by connecting bar location, and pin diameter need not be
influenced by clamp size. Free form fixators have been generally used for mandible and maxilla fractures in dogs and for fractures
of small bones in birds. But in recent years, they have been found effective for management of open long bone fractures in dogs,
sheep/goats, calves and foals. They can be used for repair of open fractures/ dislocations distal to the stifle and elbow joints.
Fractures/dislocations are reduced and immobilized using 1.2-2.5 mm K-wires fixed at different levels (at least at 2 points in each
fragment). Fixation wires in the same plane are bent and joined; and using additional wires, connecting bars/rings are constructed to
make a temporary scaffold. Thoroughly mixed epoxy putty is then applied using the scaffold as guide and by incorporating the wires
within the epoxy mold. In acrylic systems, the fixator components are constructed using acrylic columns with the use of flexible
hollow plastic pipes, which are attached to the fixation pins. The fixation of acrylic/epoxy-pin ESF is easy, less cumbersome, needs
minimal instrumentation, economical and also provides stable fixation of fractures in animals weighing up to 100 kg, hence can be
practiced by a veterinary surgeon at any remote corner in the field.
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Figure 21.8: Technique of Epoxy Pin Fixation for Fracture/Dislocation of Tarsal Joint in a Dog.
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Figure 21.9: Epoxy-Pin External Skeletal Fixation for Management of Metatarsal Fracture in a Calf.
22
Tendon Surgery
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A.M. Pawde
The tendons are important constituents of the musculo-skeletal system through which the energy is transmitted, channelised,
distributed and expressed in the form of movements. They are dense, irregular collagenous tissues composed of fibroblasts, parallel
collagen fibres embedded in a ground substance.
Tendon Morphology
Tendon is composed of water (approx 70 per cent) and dry matter (30 per cent -collagen and non-collagenous matrix).
Collagen
Type I: most prevalent
Type II: within enthesious insertion and where tendon changes its direction.
Types III, IV and V: basement membranes and endotenon
Non-Collagenous Substances
Composed of tenocytes and glycoproteins
Tenocytes: (type I, II and III)
I and II – higher metabolic activity – concerned with extracellular matrix synthesis.
Glycoproteins
Cartilage oligomeric matrix protein (COMP)-most abundant-accumulated more in high load bearing tendons (flexors) than low
load bearing tendons (extensors)-plays structural role.
Proteoglycans: Consist of Glycosaminoglycan

Chondroitin sulphate
Dermatan sulphate
Keratan sulphate
Heparin sulphate
Heparin
Hyaluronic acid
(More at metacarpo-phalangeal region than mid metacarpal-reflect functional and metabolic variance that exists between
regions of tension and compression)
Smaller Proteoglycans
Decorin (lacking-results in large irregular collagen fibrils with poor mechanical strength)
Fibromodulin
Biglycan
(throughout the tendon-influence tenocyte function, collagen fibrillogenesis, spatial organisation of collagen fibres-tendon
strength)
Outstanding feature of a normal tendon is its ability to glide through the surrounding tissue. All tendons have basic physical
characteristics of tensile strength, compactness and smooth surface. Tendons are more prone to injuries due to their superficial
location in the body.
Tendon injuries are more common in equines as compared to bovines.
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Most Commonly Affected Tendon to Injury

Equine – SDF tendon (metacarpal region)
Bovines – SDF and DDF tendons, gastrocnemius and peroneus tertius.
Canines – SDF, DDF, extensors of fore paw and common calcanean tendon
Two major problems encountered in tendon reconstruction
Formation of gap between the cut ends of the tendon
Adhesions with peritendinous structures after surgical repair
Tendonitis
Etiopathology
Physical:fatigue, poor conformation, lack of exercise, incordinated muscle activity-degenerative changes, exercise induced
hyperthermia (45ºC)-damage to matrix.
Vascular: ischaemia, reperfusion injury, fibroblast anoxia.
Diagnosis
Ultrasonography: most common technique used to diagnose tendonitis and monitor tendon healing
Tendon/lesion cross sectional area
Lesion type
Location
Fibre alignment
Change in echogenecity
Serological markers: COMP and others.
Treatment
Physical
Ice application
Bandaging
Box rest
Physiotherapy:
Active/passive exercise
Pharmacological
Anti-inflammatory drugs- in early period (less than 24 hrs)
Sodium hyaluronate-intralesional/peritendinous
Polysulphated glycosaminoglycans (PSGAGs)-inhibit macrophage activation, collagenase activity, metalloproteinase-in
acute stage and later on- improve collagen fibril organization and stimulate tenocytes to produce collagen
Beta-aminoproprinitrile fumerate (BAPM-F)- found in seed of Lathyrus odoratus (sweet pea), binds enzyme lysyl
oxidase-inhibit deamination of lysin.
Surgical
AL-SDFT desmotomy
Percutaneous tendon splitting
Counterirritation: topical blister ointments/line firing/pin firing (increase vascularity/inflammatory cell exudate).
Miscellaneous
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Low intensity ultrasound

Low frequency infrared laser therapy
Electro-magnetic field therapy.
Principles of Tendon Surgery

Anaesthesia- deep sedation and local infiltration in large animals
To minimize post-operative adhesion formation, skin incisions should not be given directly over the tendon
The skin incision should be either parallel to the proposed site or curved over the tendon or curvilinear, so that healing skin
wounds does not adhere to the tendon repair (tenorrhaphy) site
Haemostasis should be complete
All tissues should be handled gently
The tendon should be kept moist with sterile saline and should not be allowed to become dry
Skin hooks or hypodermic needles may be used for holding the tendon
Suture materials for tenorrhaphy- ideal suture material should provide firm anchorage, produce a minimum of disruption
and avoid burdening of tissue
Suture material used for tendon surgery are nylon, polypropylene, polyethylene, polyester, stainless steel, silk,
polydioxanone and polyglycolic acid (Vicryl).
Tendon Suturing Techniques

Bunnell Technique
Two needles on a single thread are used. Needle enters the tendon transversely 1 cm from the cut end and again at 45 degree
pointing towards the cut end. One loop is placed in each segment and knot tied on the outside of one segment.
Bunnell-Mayer Technique
A transverse stitch is placed in both the cut ends of the tendon. The knots are tied at the cut ends of tendon. Advantage-round
and semi round tendons are repaired more effectively; Disadvantage-not suitable for small flat tendons.
Figure 22.1
Modification of Bunnell Technique

Procedure is repeated as in Bunnell technique but instead of one loop, two loops are placed in each segment.
Locking Loop Technique (Kessler-Mason Technique)

Have two components-longitudinal and transverse. To tighten loop on tendon fibres, the transverse component should be
superficial over the longitudinal.
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Figure 22.2: Locking Loop Technique.
Modified Kessler Technique

Same as locking loop technique except that in this technique the knot is secured on the out side of one of the tendon segments.
Advantage- knot is outside the cut surface, hence no interference at the healing site.
Double Locking Loop Technique

Same as locking loop, except that instead of one loop, two loops are used so that there is increase in total number of sutures (4)
crossing the site. Advantage-increase in strength.
Triple Locking Loop Technique

Three loops of suture materials are formed, so that 6 No. of sutures are crossed at the site. Advantage-gives more strength
than single and double locking loop.
Three Loop Pulley Technique

Suture is passed in a near and far pattern comprising three loops, each of which is oriented approximately 120º from the other
two loops. Advantage-provides greater strength and resistance to gap formation between the cut ends of the tendon.
Interrupted Mattress Suture Pattern

Interrupted horizontal mattress sutures are applied. Advantage-most suitable for flat tendons.
Figure 22.3: Interrupted Mattress Suture Pattern. Overlapping Technique
Side to side anastomosis, fish mouth anastomosis. Advantage-provides stronger anastomosis. Disadvantage-requires greater
tendon length, increases the diameter of final anastomosis.
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Figure 22.4: Overlapping Technique.
Tendon Lengthening Techniques

Z-tenotomy
Accordian technique
Oblique section and gliding technique
Lange technique
Tendon Shortening Techniques

Doubling over method
Z-tenotomy and segment excision
Contracted Tendons
Malformations of the extremities or parts of them are varied in their manifestations, ranging from absence of a single structure
to partial or complete absence of the limbs. Congenital flexural deformities are seen within 1-2 weeks of birth. Contracted flexor
tendon is a common abnormality of the musculoskeletal system in ruminants especially calves, and is caused by an autosomal
recessive gene. The front limbs are primarily affected. In severe cases there may be some bony involvement, the condition is usually
bilateral. An in utero positioning may also affect the degree of disability. At birth, the pastern and fetlocks of the forelegs and
sometimes the carpal joints are flexed to varying degrees due to shortening of the deep and superficial digital flexors and associated
muscles. Slightly affected animals bear weight on the soles of the feet and walk on their toes. If not corrected, a septic arthritis of
the fetlock joints is the usual sequel.
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Figure 22.5: Contracted Tendons in a Calf.

In newborn calves/foals, contraction or shortening of the flexor tendons results in knuckling of the fetlock joint frequently and of
carpal joint rarely. The degree may vary from slight knuckling of the knee to complete flexion of the pastern and fetlock joints which
rest on the ground. These symptoms are observed within the first one to two weeks after birth. Knuckling is usually observed in fore
limbs and rarely hind limbs may be involved. Shortening of the digital flexors may be associated with other congenital abnormalities,
such as cleft palate and arthrogryposis. Besides heritable factors, abnormal posture of the foetus in the uterus may be a predisposing
factor. Trauma may be responsible for acquired nature of this condition in later life.
In mild contractions, a calf with slightly flexed fetlock joint stands and is able to walk on its toes without touching its heels on
the ground. In advanced cases, the fetlock joint cannot be extended and the animal either stumbles or falls when it is made to walk.
In more severe cases, the affected animal rests the dorsal aspect of the pastern or fetlock or both joints on the ground. Excoriation
of the skin may lead to joint infection.
Treatment
In some calves, the flexion deformity improves spontaneously. In mild cases, treatment is not required because daily normal
walking exercise is sufficient to stretch the tendons, which corrects the condition in due course of time. In other cases, the affected
joint has to be kept in forced extension by a splint or a plaster cast to induce the inverse myotatic reflex with relaxation of the flexor
muscles.
The limb should be well padded and the splint applied to the caudal aspect. The splint should extend from just above the foot to
the elbow or hock. The support enables the animal to bear weight on toes and to use the limb so as to stretch the tendons gradually.
The splint may be removed after 1-3 days to check for complications like pressure sores and oedema. Following massage, the splints
may be reapplied. A plaster cast can also be used for two weeks so as to keep the tendons in a relaxed position and to allow the
animal to walk normally. In severe cases or if above methods fail, a tenotomy of either one or both flexors is done and the limb
immobilized. In a few cases, desmotomy of the suspensory ligament may become necessary.
For tenotomy, the animal is sedated and controlled in lateral recumbency with the affected limb lowermost. After local
anaesthesia of the site, a skin incision is made on the medial aspect of the limb and parallel to the tendon. A mid metacarpal or
metatarsal site is preferred where the tendon lacks the synovial sheath. The subcutaneous tissues are separated by blunt dissection,
and the blood vessels are identified and retracted. Both tendons are identified and separated by blunt dissection. The affected tendon
is transected while forcibly extending the fetlock joint. The skin wound is then sutured routinely. The gap between the two retracted
ends of the tendon will fill with fibrous tissue. Z-tenotomy for lengthening tendon is an alternative technique for correction of the
contracted tendons. A longitudinal incision is made in the center of the exposed tendon. At each end of the incision, a transverse
incision is made but in opposite direction. The ends are then sutured. The skin incision is closed. The wound is protected by sterile
bandage and a plaster cast then applied.
23
Teat Surgery
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Mozammel Hoque
The udder and teat are vulnerable to external trauma or injury because of their anatomical location, increase in size of the udder
and teat during lactation, faulty methods of milking, repeated trauma to the teat mucosa, injury by teeth of calf, unintentionally
stepped teat, and paralysis resulting from the metabolic disturbances at parturition. Though teat surgery appears to be of minor in
nature, it poses a great challenge to the dairy practitioner because of its glandular nature. Teat surgery is a demanding test of the
skill of the surgeons. It demands proper surgical management and good aftercare that can save valuable animals from loosing one or
more quarters or being culled.
Anatomy
Mammary glands are modified skin glands. In cows and buffaloes the mammary glands consists of four quarters. The glandular
tissue of the udder is divided into two main halves-right and left, by a complete septum. The suspensory apparatus, and blood and
nerve supplies of the two halves are independent of each other. Each half consists of a cranial and caudal quarter. The two quarters
of each half have independent glandular tissue but common blood and nerve supply, and lymph drainage. The teats are membranous
tubes consisting of skin, muscular layer (superficial longitudinal and deep circular fashion), fibrous layer and mucosa. The closing
mechanism of the teat consists of circular muscles forming the sphincter, the rosette of Furstenberg and circular elastic fibres
around the streak canal. In sheep, the udder consists of two halves with one teat each, and each half resembles one quarter of
bovine udder.
Figure 23.1: Commonly Used Teat Instruments.
1. Hug’s teat tumour extractor, 2. Alligator forceps, 3. Hudson’s teat spiral, 4. Teat dilator, 5. Teat siphon, 6.
Larson’s teat tube, 7. Three-ring teat slitter 8. Small artery forceps, 9. Lichy teat knife-blunt point,10. Lichy teat
knife-sharp point.
Restraint and Anaesthesia

Animal may be restrained within a crate with one leg lifted.
Local anaesthesia at the teat base with or without sedation and with the animal in lateral recumbency.
Xylazine alone is effective for minor procedure, but contraindicated in advanced gestation and possible recumbency.
Diagnosis
History and clinical examination
Probing with sterilized teat siphon
Radiography- positive contrast and double contrast radiography are used to detect structural teat abnormalities.
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Ultrasonography- used to detect the level and extent of obstruction, depth of laceration and echo-intensity of udder tissue.
Theloscopy- teat endoscopy, is a useful technique for diagnosis and therapy of covered teat injuries.
Preparation for Surgery

Withholding feed and water for 12-24 hrs when surgery is done in recumbent position. Cleaning and washing of udder and teat
with antiseptic solution.
Figure 23.2: Sonogram of Gland Cistern.
Figure 23.3: Sonogram of Obstructed Teat.
Surgical Diseases
Some common forms of surgical affections are laceration, fistula, obstruction, stenosis and thelitis.
Supernumerary Teats
Congenital and inherited condition. Small teats are commonly caudal, but sometimes are attached to the normal teat. Remove
when 1-9 months old, and never within 1 month of parturition as it may lead to oedema, wound dehiscence, infection and mastitis.
Crush at the base with small Burdizzo and resect with knife along the inner edge of blades. Line of section should be cranial to
caudal, not transverse so that subsequent scar merges into natural folds of udder skin. Suture only if wound edges separate.
Alternative technique is to remove surgically under local analgesia by making two elliptical incisions at the junction of the teat and
skin of the udder. The wound is closed with interrupted sutures using a non absorbable suture material.
Teat Lacerations
Incidence of teat laceration is relatively higher in goats due to their pendulous udder and long teats. Superficial wounds are
treated as standard with other tissues. Large wound involving skin and muscularis may require suturing. Deep wound involving
mucosa is best sutured with the animal in lateral recumbency after deep sedation. A ring block is produced and a tourniquet is
applied at the base of the teat to check haemorrhage and to prevent milk flow into the cistern. After preparation of the affected teat,
a sterilized teat siphon is inserted and debridement is done to remove the dead tissue. The mucosa is closed with simple continuous/
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interrupted suture with absorbable suture material. The submucosa and muscularis are then closed together using simple continuous
suture and finally the skin is closed. Post-operatively antibiotics are infused into the affected teat for 4-5 days. Milk is removed after
insertion of a sterile teat siphon for a few days for smooth haling.
Teat Fistula
Teat fistula is an abnormal opening between the teat cistern and the teat surface through which milk flows out in lactating
animals. If the fistula is very small, mild chemical cauterization or electric cautery may be helpful. Large fistula needs reconstructive
surgery. Surgery should be delayed if the teat is highly inflamed. For repair, two elliptical incisions are given on the skin edges for
debridement and undermining. The wound is then closed as mentioned earlier for deep lacerations.
Figure 23.4: Teat Fistula Before Surgery.
Figure 23.5: Teat Fistula After Surgery.
Teat Spider (Membranous Obstruction)

May be congenital or acquired. The obstructing membrane may be thick or thin and located high at the base of the teat or
lower down in the cistern. Palpation shows fluctuating milk above the obstructions but milking is not possible. The teat is prepared
for surgery under local analgesia. A Hudson’s teat spiral is introduced up to the membrane for deep penetration with 3-4 revolutions,
and the instrument is then withdrawn. Alternatively, the membrane can be slit in 3-4 directions using a small teat bistoury. Flow of
the milk generally keeps the teat cistern patent. It is recommended during milking not to milk the affected quarter completely to
avoid a stricture.
Contracted Sphincter (Hard Milker)

It may be congenital or acquired. There is a small stream of milk leading to prolonged milking time and trauma to the teat.
Under local analgesia, the enlarging procedure may be accomplished by inserting a Litchy teat knife, ringed teat slitter or Stoll
teat bistoury. The opening in the sphincter is maintained at the desired size by inserting a Larson teat tube and leaving it in place for
5-7 days. Milking is accomplished by removing the cap of the tube.
Free Milker or Leaker (Enlarged Teat Orifice)
Milk leaks from the teat at times other than milking due to a relaxed or traumatized sphincter. Injection of minute amount of
sterile mineral oil or Lugol’s solution using a 22-26 G hypodermic needle around the orifice may help to reduce its size to the desired
level. This may have to be done more than once to obtain the optimal size for milk flow.
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Imperforate Teat (Occlusion of Teat Orifice)

May be congenital or acquired. For treatment, an 18 G hypodermic needle is forced into the teat cistern under local analgesia.
Once the milk starts coming out, the teat orifice is treated as mentioned for contracted orifice.
Lactolith (Milk Stone)

Lactoliths in the teat cistern form due to mineral deposits and may interfere in milking. Small lactoliths can be removed by
milking them out through the teat orifice. A mosquito forceps can be used to crush a large lactolith and then small pieces can be
removed by milking. If the lactoliths are hard and large, the sphincter may be slit and removed.
Papilloma (Warts)
They are finger like projections originate from the skin surface of the teat. A tight ligature at the base of the wart is applied to
drop off it or surgically removed.
Polyps
Generally pea sized growth attached to the wall of the teat cistern, which interferes with milk flow. A teat tumour extractor, a
curette or a teat polyp extractor may be used to remove the growth.
Thelitis
Acute or per acute inflammatory condition of one or more teats, which is distinct from infectious mastitis where culture of milk
samples shows no pathological bacteria. Intralesional methylprednisolone and hyaluronidase along with systemic antibiotic and
antihistamine drugs provide superior results.
Amputation of Mammary Gland

Indicated in gangrenous mastitis. General anaesthesia or epidural block is used. For unilateral gland amputation, the incision is
placed at the superiolateral aspect of the gland about 2-3 cm away from the intermammary groove. For bilateral amputation, incision
should start at the midline caudally near the base of the udder to extend cranially along the base. The skin is resected from both
edges. One of the glands is dissected away from the line of cutaneous incision to expose the external pudic artery and vein located
near the external inguinal ring. Similarly, reflection of the cranial part of the gland will expose the perineal artery and large
subcutaneous vein. All the vessels should be doubly ligated with a strong absorbable suture material. If both glands need removal,
the procedure is repeated on the other gland. The skin flaps are closed.
Recent Trends in Teat Surgery

Ultrasonography facilitates accurate diagnosis of pathological conditions which are sometime impossible to detect by clinical
examination. Linear or sector transducers of 5-10 MHz have been used for the purpose. This non invasive technique enables
clinician to detect the level and extent of abnormalities within the canals, sinus and glandular tissue of the gland. The udder and teat
are amenable to sonographic imaging because of its superficial location and has the potential to diagnose different conditions of the
organ.
Endoscopy is a new, modern method used in the diagnosis and therapy of the teat disorders. Two methods of teat endoscopy
can be used: endoscopy through the teat canal or endoscopy from the side access (through the wall of the teat). Apart from
visualization of inaccessible organs, endoscopy enables surgical operations within the teat canal. This method necessitates the use of
the theloresectoscope (length 150 mm, diameter 2.7 mm), cold light source, fiber optic light cable, endoflator and cold light source,
fiber optic light cable, endoflator and trocar. Theloscopy using an endoscope has been proven quicker, less invasive, atraumatic, and
free of major post-operative complications such as haemorrhages, inefficient wound healing and mastitis. Most of the currently
applied techniques for mammary gland endoscopy have curative purposes and focus on treatment of teat injuries and stenosis in high
yielding dairy cows.
Low level laser therapy effects healing of teat and udder wounds by minimizing inflammation, improvement of skin regeneration
and enhancement of collagen synthesis.
Open teat surgery is the surgical procedure of cutting through the teat wall to enable the surgeon to correct problems in the teat
or udder cistern. By this approach the surgeon can visualize the problem and exercise sound surgical judgement in correcting it. This
is superior to blind ripping and cutting through the streak canal. Correct suturing of the incision in layers is most important. Provision
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of drainage is also recommended.

Silicone implant and NIT natural teat inserts have been used to keep the teat canal patent after surgery.
Index
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A
Aanes technique 110
Accidental traumatic wounds 35
Affections 47
Alcohols 14
Anaesthesia 48, 73, 76, 165
Anatomy 47
Antisepsis 12
Antiseptic agents 14
Asepsis 12
Aseptic (surgical) wounds 34
Aseptic technique 12
Atresia ani 99
Atropine 10
Aural haematoma 51
B
Bandaging 37
BCS score 9
Blind method 86
Bovines 79
Bunnell technique 158, 159
Bunnell-mayer technique 158
Burdizzoo castration 125
C
Caesarean section 139
Canine mammary carcinoma 44
Canine mammary tumour (CMT) 42
Casting 152
Castration 123
Catgut 21
Cellulitis 36
Chemical (gas) sterilization 17
Chemical dehorning 48
Chemical disinfection 7
Chemical peritonitis 7
Chemical sterilization 15
Chemotherapy 45
Cherry Eye 62
Chlorhexidine 14
Cold chemical sterilization 19
Collagen 21
Complications 75, 78, 111
Connective tissue tumours 39
Cosmetic dehorning 48
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Curcuma longa 36
Cushing suture 28
Cystorrhaphy 118, 121
D
Dehorning 48
Deoxyribonucleic acid (DNA) 17
Dermoids 64
Diagnosis 43, 80, 90
Diphenhy dramine 10
Disinfection 12
Double locking loop technique 159
E
Ectropion 61
Elastic banding 124
Elastrator 127
Elective sterilization 133
Electrosurgery 18
Emasculatome 124
Emergency drugs 10
Endoscopic machines 3
Endothelial tumours 40
Entropion 59
Epinephrine 10
Epithelial tumours 40
Epoxy-pin fixation systems 152
Eriolaenia quinquelocularis 37
Ethylene oxide (ETO) 17
Etiology 99, 112
Etiopathology 156
External fixation techniques 146
External skeletal fixation techniques 150
Eye affections 56
F
Fascia lata 22
Field level surgery 1, 5
Filtration 17
First aid 146
Fistula 36
Fluoroscopy 2
Foreign body syndrome (FBS 79
Formaldehyde 15
Fractures 145
G
Gambee suture 29
Gastrocnemius tenectomy 2
General anaesthesia (GA) 58
Glycoproteins 156
Glycosaminoglycan 156
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H
Haematoma 52
Haemorrhage 35
Hernia 98
Horizontal mattress suture 27
Horn avulsion 49
Horn cancer 49
Hydrogen peroxide 15
I
Incision 73
Infected wound 35
Interrupted mattress suture pattern 160
Intestinal obstruction 89
Intussusception bypass surgery 95
Iodine compounds 15
Ionizing radiation 18
K
Kangaroo tendon 22
L
Lactolith 168
Laparorumenotomy 83
Laparoscopy 3, 5
Lateral recumbency 87
Livestock 1
Lymphoid tissue tumour 40
M
Mammary gland 168
Medial patellar desmotomy 84
Midline incision approach 135
Modified kessler technique 159
Modified thomas splints 150
N
Natural absorbable suture materials 21
Newberry knife technique 124
Non-collagenous substances 155
O
Ocular tumours 70
Ocular worms 56
Oesophageal obstruction 75
Oesophagotomy 72, 77
One stage repair (Goetz technique) 109
Ovariohysterectomy 133
Overlapping technique 160
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P
Papilloma 168
Patellar desmotomy 2
Pathophysiology 89
Penetrating 33
Perineal laceration 106
Phenols 15
Physiotherapy 3
Pinhole castration 131
Plasma sterilization 18
Plaster cast 147
Poisoned wounds 33
Polydiaxanone 22
Polyglycolic acid 22
Polypropylene 23
Polyps 168
Polyvinyl chloride (PVC) 18
Polyvinylpyrrolidone 15
Positioning 107
Post-operative Care 104
Post-operative management 98
Post-operative rehabilitation 11
Post-scrotal urethrotomy 119
Pre-surgery meeting 7
Prognosis 41
Prognostic factors 46
Punctured wounds 33
Purse string suture 31
Pyaemic or metastatic abscess 37
Q
Quaternary ammonium compounds 15
R
Radiography 2, 81, 165
Rectal affections 106
Rectovaginal fistula 99, 102
Respiration rate 8
Restraint 48
Running suture 26
S
Septic wound 34
Short scrotum method 124
Simple interrupted suture 25
Sterilization 7, 12, 15
Stifle joint 85
Subcutaneous suture 26
Surgery 13, 44
Surgical anatomy 72, 134, 140
Surgical diseases 166
Surgical equipment 15
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Surgical equipments 12
Surgical excision 41
Surgical infections 13
Surgical instruments 7
Surgical management 89, 103, 114
Surgical procedure 73, 134
Surgical technique 38
Suture techniques 23
Synthetic absorbable suture materials 22
T
Teat fistula 167
Teat lacerations 166
Teat surgery 164
Temperature 8
Tendon lengthening techniques 161
Tendon shortening techniques 161
Tendon surgery 155, 158
Tendonitis 156
Thelazia spp. 56
Thelitis 168
Theloscopy 165
Thermal dehorning 48
Thermal energy 16
Thermoregulation 9
Three loop pulley technique 160
Tracheostomy 72, 74
Transfixation pinning 152
Traumatic emphysema 36
Traumatic neuralgia 35
Traumatic ocular proptosis 66
Traumatic reticuloperitonitis (TRP) 79
Tridex procumbens 37
Triple locking loop technique 159
Tube cystostomy 116, 122
Tumours 39
U
Ulcerative wounds 33
Ultrasonography 2, 81
Unilateral orchiectomy 124, 128
Urethrostomy 115
Urolithiasis 114
Uterine diseases 133
V
Vaginal prolapse 2
Ventral herniorrhaphy 96
Virulent wounds 33
Vitamin deficiency 38
W
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Wrinkling 54
X
X-rays 5

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Handbook On Field Veterinary Surgery (VetBooks - Ir) PDF

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VetBooks.

Astral International Pvt. Ltd.

Cataloging in Publication Data—DK

Published by : Daya Publishing House ®

Laser Typesetting : Classic Computer Services , Delhi - 110 035

Printed at : Thomson Press India Limited

1. Prospects and Recent Advances in Field Level Surgeryin Livestock

2. Basic Considerations for Field Level Surgery

3. Asepsis and Sterilization

4. Sutures and Suturing Techniques

8. Aural Haematoma in Dogs

9. Management of Basic Eye Affections in Animals

11. Foreign Body Syndrome in Bovines

12. Medial Patellar Desmotomy

13. Surgical Management of Intestinal Obstruction

14. Ventral Herniorrhaphy

15. Atresia Ani and Rectovaginal Fistula

16. Perineal Laceration and Rectal Affections

17. Management of Urolithiasis in Ruminants

18. Castration of Male Animals

19. Ovariohysterectomy in Canines and Felines

20. Caesarean Section

21. Management of Fractures

22. Tendon Surgery

23. Teat Surgery

Devi, Kh. Sangeeta

Gupta, Ajay Kumar

Saxena, Abhishek Chandra

Singh, Gaj Raj

Gaj Raj Singh

afternoon or evening surgery and cloudy days.

Sterilization of Surgical Instruments and Supplies

Minimal Data to be Recorded

Pulse rate and quality.

Food and Water

Surgical Risk Patients

Minimum Surgeon Knowledge Base

Hakim Athar and B.A. Moulvi

Principles of Surgical Asepsis

Prevention of Surgical Infections

Preparation of Patient for Surgery

Preparation of the Operating Facilities

Common Antiseptic Agents

Quaternary Ammonium Compounds

Sterilization of Surgical Equipment/Instruments

Chemical (Gas) Sterilization

Cold Chemical Sterilization

Properties of an Ideal Suture

Natural Absorbable Suture Materials

Synthetic Absorbable Suture Materials

Polyglactin 910 (Vicryl)

Non-absorbable Suture Materials

Name of Pattern Wound Edge Consideration Possible Indications

Connell Inversion Interrupted/ Hollow organs like stomach, uterus, urinary

Tissue Consideration Suture Pattern Material Size

SA: Small Animals and LA: Large Animals.

Figure 4.1: Simple Interrupted Suture

Figure 4.2: Simple Continuous Suture

Figure 4.3: Running Suture