Minor veterinary Surgery

By: Mohammedseid
october 2022
 Principle of surgery
• ASEPTIC TECHNIQUE: hand-scrubbing, gowning
and gloving

• The use of scrub suits and shoes or at least shoe covers

is to be encouraged
Hats and masks reduce contamination from personnel
and should be worn at all times in theatre
• Sterile gowns present an aseptic barrier between the
surgeon and the patient.
• Sterile gloves must be used to cover scrubbed hands.
• REPARATION OF THE SURGICAL SITE Preparation
of the surgical site involves five stages:
1. Removing hair from the site
2. Performing a disinfectant scrub to
remove contaminating bacteria
3. Moving the patient to the aseptic
operating theatre
4. Positioning the patient for surgery
5. Draping the patient
• Surgical instrument
• Needle holder
• Scalple blade
• Thumb forcepes
• Heamostatic forcepes
• Tissue forceps
• Seccisor
• Retractors
• Cleaning and maintaining instruments
• • Instruments should be cleaned as soon as possible after surgery to
prevent blood drying and fixing and to reduce the build-up of bacteria
• • All sharps should be disposed of in an approved sharps container
(suture needles should be carefully inspected and handled separately)
• • Delicate surgical instruments (ophthalmic or other fine dissecting
instruments) should be separated to reduce risk of damage
• • Instruments should first be rinsed in cold water: rinsing in hot water
tends to fix blood and makes it more difficult to remove from surfaces
• • Debris should be removed by soaking in warm water containing (pH-
neutral) detergent. Detergents containing ammonia should be avoided
as these tend to discolour instruments
• • The detergent and remaining gross soiling should be removed by
gentle scrubbing and rinsing with clean water
• An ultrasonic cleaner should then be used to remove
fine debris.
• The instruments should be laid out on to absorbent
paper and dried
• Finally, the instruments are grouped together into kits
and packaged according to appropriate sterilisation
methods
 Suture material and pattern
• suture materials are
• Absorbable, e.g. catgut, polyglycolic acid,
polyglactin 910, polydioxanone, polyglyconate,
poliglecaprone 25, glycomer 631, polyglytone 6211,
lactomer 9-1.
• Non-absorbable, e.g. silk, nylon (polyamide),
polyester, polypropylene, polybutester, polymerised
caprolactum, stainless steel.
• tension-relieving sutures are covered later;
appropriate to this text are skin suture patterns,
which may be categorised thus:
• • Subcutaneous or subcuticular sutures
• • Skin sutures:
• • Interrupted (simple, horizontal mattress or
cruciate)
• • Continuous (simple continuous, Ford
interlocking)
• Suture needle
• Knots The knot is the weakest part of any
suture and consequently care must be taken to
ensure it is well tied
• HAEMOSTASIS - DEALING WITH BLEEDING
• Swapping
• haemostatic forceps
• ligature
 Wound management
• WOUND CLASSIFICATION
• The type of injury may be
• incisional
• abrasions/grazes
• degloving/shearing/avulsion
• puncture
• firearm
• iatrogenic (bandage wounds)
• miscellaneous (bite or sting from e.g. snake,
artropod, jellyfish)
• The sanitary status of a wound may be:
• Clean: there is no inflammation present and no
sign of contamination (surgical wounds)
• Clean contaminated: there is no inflammation
present but some superficial contamination.
• Contaminated: there is little or no
inflammation present, but contamination is fairly
heavy and may involve high bacterial numbers.
• Dirty: inflammation is present and there is a
purulent discharge.
 Wound management
• Wounds with appreciable contamination may be
treated in a number of ways:
– By minor debridement of the wound edges and immediate
closure of the wound (primary closure)
– By regular dressing changes and antibiosis until infection is
controlled, then debridement and closure (delayed
primary)
– Allowing a granulation bed to form and then closing by
grafting techniques (secondary closure)
– Allowing the wound to heal by granulation and re-
epithelialisation (secondary-intention healing)
 Step
• Restraint and Analgesia
• Initial Preparation
• Wound Exploration
 Débridement

• Débridement is an effective way to reduce the

bacterial load within a wound and to minimize
necrotic tissue.
• The most common types of débridement are
sharp, mechanical, chemical, biological, and
autolytic
Debridement

• Hair should be clipped around the wound (if not already done)
• The skin surrounding the wound should be prepped as for
surgery, using povidone-iodine or chlorhexidine.
• The wound should be considered a sterile surgical site: sterile
drapes should be used and mask, hat, gloves and gown worn
• The wound should then be re-examined; any remaining debris
should be removed using forceps or swabs (being careful not to
force debris deeper into the wound)
• Any obviously necrotic tissue should be removed by dissection
Necrotic muscle tissue may be cut away, but care should be
taken IQ avoid nerves and blood vessels. Ligaments and tendons
should be minimally debrided.
• The skin edges should be 'freshened up' by sharp
dissection, using a no. 11 scalpel blade perpendicular
to the skin.
• Gentle lavage during the debridement process aids
in removing dissected debris. Surgical suction, if
available, is most useful
• Haemorrhage should be controlled with, as blood is
an excellent culture medium for bacteria.
• • En bloc debridement is a useful technique for speedy
debridement of a moderately deep contaminated wound
The wound is lavaged and closed using a simple continuous
suture pattern or else tissue glue may be used. The closed-
off wound is then treated as a 'lump' and excised, being
careful not to penetrate the wound cavity. The excised
wound is thus kept isolated from the surgical site, providing
a sterile debridement and reducing the chance of wound
infection
• • Once debridement of the wound is complete, lavage with
sterile saline is repeated
• • At this stage, a swab may be taken from the deep part of
the wound and sent for culture and sensitivity
• • The wound may now be closed
• primary closure following debridement
• In order to be amenable to debridement and
primary closure, a wound must fulfill certain
criteria:
• The wound must be in an area where there is
sufficient skin to enable primary closure following
debridement.
• Damage must be limited to more superficial tissues.
An exception to this is where the wound is still within
the 6-h grace period and minimal debridement of
deeper tissues is required
• There must be no sign of infection.
• Delayed primary closure
• In some cases, it may be difficult to lavage a wound
adequately to the degree of readying it for primary
closure. In these situations,
 application of an adherent dressing such as sterile gauze
soaked in saline (wet-to-dry) will aid debridement of the
wound.
 The dressing should be changed daily.
 Each dressing change should be performed under
aseptic conditions, with hat, mask, gown and gloves
 Removing an adherent dressing is often painful and the
patient may require sedation or even general anaesthetic
for each dressing change.
• After 3-5 days, the dressing should come away
from the wound bloody, but not covered with
discharge. At this stage the wound is ready for
delayed primary closure
• Sharp dissection is carried out to provide
fresh skin and wound edges and the wound is
closed
• Secondary closure .
avulsion injuries, shearing injuries and burns wounds that result in skin deficits may
require closure by reconstructive skin closure techniques or by grafting.

• Initially, the wound should be cleaned by lavage and gross contamination removed.
• An adherent dressing (sterile saline-soaked cotton gauze: wet-to-dry) should be
applied to the wound and the dressing changed daily or twice daily until
granulation tissue can be seen to be forming in the wound (usually 3-5 days)
• Strict aseptic technique (hat, mask, gown, gloves and drapes)
• Once granulation tissue has appeared, a nonadherent dressing should be used. A
hydro-colloid gel (e.g. Intrasite, Smith & Nephew) is ideal at this stage and will aid
in microdebridement of necrotic tissue. A nonadherent cotton pad (e.g. Melolin,
Smith & Nephew) is placed over a layer of Intrasite gel and a bandage applied
• • The dressing should be changed daily until the granulation tissue has formed a
smooch bed.
• • Presence of a mature granulation bed implies absence of infection and at this
stage an attempt may be made to close the skin over the bed by a variety of
reconstructive techniques
• Second-intention healing
• Where skin closure is not considered advisable or achievable the
wound may be left to heal by second-intention healing .
• The wound is cleaned by lavage and sharp debridement of
necrotic tissue as above
• Steps are followed as above to induce a bed of granulation tissue
• Once a uniform granulation bed has been achieved. The dressing
may be changed every 3-5 days at this stage (strict asepsis should
be maintained)
• Re-epithelialisation and wound contracture (cicatrisation) will
result in wound-healing after 4-6 weeks, depending on the size of
the wound
• Dressings are required until an epithelial layer covers the entire
wound
• Antibiotics
• In deciding whether to use antibiotics in wound
management:
 Uncomplicated wounds which are treated within
the 6-h golden period should not require antibiotics
 For more complicated or long-standing wounds,
start with a broad-spectrum antibiotic (an
amoxicillin/clavulanate, e.g. Synulox, Pfizer, 12.5-25
mg/kg PO BID)
• In the case of severe wounds intravenous
broad-spectrum antibiotics (e.g . a second-
generation cephalosporin, such as cefuroxime
(Zinacef, Glaxo, 20-50 mg/kg IV) .
• When dealing with heavily contaminated
wounds, topical antibiotic therapy can also be
used.
Surgical techniques
A. Castration in bull
• Burdizzo castration is used to crush the
spermatic cord and the surrounding
vessels lead to loss of blood supply to
testis
• Use local infiltration of local anaesthesia

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Indications:
• Enlarged prostate

• Improved meat quality

• Prevention of breeding nuisance

• Scrotal and perineal hernia

• Irreparable injury of testes

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Technique
• Pinch the cord to the outside edge of the
scrotum b/n your thumb and forefinger
• If right handed, use your left hand to hold
the cord and your right hand used to
operate the Burdizzo
• Place the jaw with the projections on the
front side of the scrotum
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• The jaws should be placed just above the
top of the testicle
• Close the Burdizzo for 10 seconds

• Release the Burdizzo, move it to a new

site 1 cm below your first site and repeat
steps on opposite side
• The operated area painted with Tr. Iodine
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B. Castration in horse
• Castration is one of the most common
surgical procedures performed in equine
practice
• Castration in horses is usually done to
facilitate management
• Castration age is 12-18 months
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Anaesthesia:
• Sedation and regional anaesthesia

• Xylazine followed by ketamine

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Surgical Technique
• Castration is performed through separate
incisions for each testis
• Incisions located 1cm from the median
raphe
• The lower testis is grasped b/n thumb
and forefingers
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• Skin incision made for the length of the
testis through the tunica dartos and scrotal
fascia leaving the common vaginal tunic
• Pressure is exerted by the fingers to
extrude the testis with the common tunic
• Incise the common tunic over the cranial
pole of the testis

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• Testis is released from the common tunic

• Grasp the testis and strip off s/c tissues

from the common tunic
• Separate vascular bundles from non
vascular bundles of spermatic cord
• The non vascular bundles are severed and
crushed with the emasculators after ligation

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• The vascular bundle is ligated using 1-0 or
2-0 chromic catgut and apply emasculator
distal to the ligatures to remove the testis
• Keep the emasculator in the crushed
position for 1-2 minutes
• The other testicle also removed in a similar
manner

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Postoperative management
• Antibiotic coverage
• Close observation for the first 24 hours
after surgery
• It should be separated from the mares for
a week

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 dystocia
• Dystocia means difficult birth.
• Always the fetus determines the day and the
dam the day of parturition

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 Initiation of parturition
Stages of parturition/labor
First Stage:
• It is the preparatory phase for birth (2-6hrs)
• The cow is restless separate from the herd,
dilation of the cervix, tail raised, arched back,
straining, uterine contraction coordinated and
regular (E2+PGF) amnion dilates the cervix,
cervical mucous released, allanto-chorion may
break
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 Initiation of parturition
Second Stage
• Appearance of the water bag
• Expulsion of the fetus (0.5-3hrs) → 1 hr after
the water bag is seen check if help is needed
• Contraction of abdominal muscle due to
pressure on the cervix
• Strong uterine contraction due to sysnergysitic
action of E2, PGF and oxytocin.
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 Initiation of parturition
Third Stage
• Expulsion of the fetal membranes and
placenta
• Resumption of uterine involution
• It takes 0.5 hr to several days according to the
spp

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 Obstetrical relationship of the fetus to the
dam

• This described by some obstetrical

terminologies.
• These help to correct some obstetrical
abnormalities in the treatment of dystocia.
• These terms are: Presentation, position and
posture.

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1. Presentation
→ relationship between the long axis of the fetus
and the maternal birth canal.
• Longitudinal presentation (anterior or posterior)
forelimbs extended and so the head lying
between the legs or the hind-libms extended.
• Transverse presentation (ventral or dorsal trunk)
X right cephalic or left cephalic.
• Vertical presentation (ventral or dorsal trunk) X
cephalo-sacral or cephalo-pubic. Rare dog-sitting
position in equines.

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 Obstetrical relationship of the fetus to the
dam
2. Position
• →relationship between the surface of the maternal
birth canal and fetal vertebral column/dorsum.
• Description→ dorso- sacral, pubic or ilial (right or
left)
3. Posture
→ Description of a movable appendages of the fetus:
Flexion/extension of the limbs, neck and head
including upward and downward deviations.
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 Dystocia in the cow
Maternal Cause
1. Expulsive Force
• Lack of uterine contractility (uterine inertia)→ primary or
secondary (prolonged gestation).
• Lack abdominal force
2. Condition of the birth canal
• Inadequate pelvis (breed, nutrition, developmental,
injuries, body condition).
• Insufficient dilation of the cervix and the uterus
(hormonal, inertia, torsion)
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 Dystocia in the cow
Fetal causes of dystocia
1. Fetal oversize (relative or absolute in relation
to the size of the birth canal.
i.Birth weight*
ii.Sex
iii.Liter size/twining

2. Abnormal presentation, position and posture

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 Dystocia in the cow
• The three barriers in the delivery of the calf
are: head, shoulder and hips
• Therefore the common forms of dystocia are:
1. Difficulty of getting the head coming out in
anterior presentation
2. The fetal chest may get stuck in the pelvis
3. Big calf that results in hip lock

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 Dystocia in the cow
Abnormal presentations
• Carpal flexion(s)
• Shoulder flexion(s)
• Head flexion/deviation
• Neck flexion
• Anterior longitudinal dorso-pubic presentation
• Hock flexion(s)
• Breech birth/presentation
• Left or right cephalic dorsal transverse presentation
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Normal P,P and P

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Abnormal P, P and P

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 Obstetrical Procedures
1. Mutation → correction of fetal orientation by hand or
obstetrical instruments.
2. Repulsion → pushing the fetus backward so that space
is available for correction abnormal presentations.
3. Rotation → turning of the fetus on its long axis to bring
it to dorso-sacral position.
4. Version → rotation of the transverse or vertical
presentation into longitudinal presentation.
5. Extension → correction of flexions and deviations of
the limbs and head
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 Obstetrical Procedures
6. Traction/forced traction → applying external force
on the fetus to pull it out through the birth canal.
– Recommendation: uterine inertia and narrow pelvis
– Risk: application before or without correction and
inordinate force(>4 men)
– Follow the arc of the fetus during traction
7. Episiotomy→ widening of the external outlet of
vagina to all the passage of the fetus.Slightly
lateral incision.

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 Obstetrical Procedures
8. Fetotomy → cutting into pieces of the fetus
to reduce its size so that its withdrawal is
easier. Recommended when fetus is dead or
when other procedures fail.
9. Caesarian section → delivery of the fetus by
surgical operation

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 Incidence of dystocia

• Higher in cattle than in other species (3-5% more)

• More common in confined and primipara than in
free ranging and multipara
• In 85% of the cause is relative oversize or postural
abnormalities in cows
• In mare only 25% of the cases are associated with
the fetus.

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Vaginal and uterine Prolapse - cattle
Vaginal Prolapse
 Vaginal or uterine Prolapse - cattle

• on arrival induce caudal epidural analgesia (5 ml lidocaine 2% + 0.5

ml xylazine 2%) to eliminate straining or using epidural lidocaine
only
• The patient is controlled in standing position
 vaginal or uterine..
• Surgical technique:
• uterus should be supported in slightly elevated position in clean
cloths until veterinary assistance arrives
• The prolapsed vagina and/or uterus are thoroughly cleaned with
mild antiseptic
• if down, put cow into sternal recumbency with hind legs in caudal
extension,
• place uterus and underlying cloth on a board placed across both
hocks in recumbent cow
• operator commences to replace the uterus little by little, starting
with those portions nearest the vulval lips.
• insert vulva sutures to prevent the possibility of re-prolapse
vaginal or uterine….
vaginal or uterine….
vaginal or uterine….
vaginal or uterine….
• Surgical technique cont ……
– Prevent recurrence by Buhner’s technique
• A 14-15 cm long umbilical tape needle is threaded with 70
cm umbilical tape and
• The needle is deeply inserted in a dorsal direction 6 cm
lateral to the vulva and about 4 cm above the ventral
commissure of the vulva
• The needle is taken out 6 cm lateral to the dorsal commissure
of the vulva.
• The needle is similarly passed through the tissues on the
opposite side of the vulva from dorsal to ventral side
• Two ends of the umbilical tape are then tied at the ventral
commissure of the vulva enough to prevent the prolapse
 vaginal or uterine….

A = Prolapsed vagina.
B = Insertion of umbilical tape
needle above the ventral
commissure of vulva.
C = Umbilical tape coming out
lateral to dorsal commissure
of vulva.
D = Insertion of needle from dorsal
to ventral side.
E = Figure of '8' suture at ventral
commissure of vulva.

Buhner Technique
 vaginal or uterine….

• Surgical technique cont …

– Other techniques to prevent recurrence

Flessa sutures
Postoperative care:
– Treat vaginitis, cervicitis, traumatic wounds
– Keep the animal on an inclined platform with hind
quarters elevated
– Even if the animal shows no clinical signs of hypocalcaemia,
give calcium borogluconate
– parenteral antibiotics.
– The external area of vulva should be cleaned daily protected by
daily vaseline ointment.
– after reduction inject oxytocin (50–100 iu, i.m.) to speed
involution
– The suture is removed once straining has stopped and no chances
for recurrence (24 hrs latter)
 Phimosis and Paraphimosis
Phimosis
Constriction of preputial orifice ( prevent extrusion of
Penis or Penis is prevented from coming out of the prepuce)

 Occurrence (congenitally or acquired)

 Acquired cases often accompanied with laceration of prepuce

Management
1. Medical – Acquired cases
      

Medical treatment – Irrigation of preputial cavity with mild

antiseptics and administration of antibiotics locally
 Phimosis and paraphimosis (cont..)
2. Surgical – Congenital phimosis and acquired
   

Procedure
 Restraining – lateral recumbency
 Anaesthesia – High epidural or circular infiltration
 Incision – Passing a blunt pointed scalpel through the
orifice into the lumen (5cm incision)
 Closure – close the parietal layer of the prepuce to the
internal layer
 Phimosis and paraphimosis (cont..)
Paraphimosis
 Penis is prevented from retracting back into the prepuce
( hematoma, tumour )
the resulting swelling tend to trap penis in extended position
 when bull stepping on penis while it is in extended position during
mating (usual cause)
 Partial phimosis could also cause paraphimosis
 Accompanied with contusion (penis and prepuce )
Management
Early cases (Fresh)
Replace & apply purse string suture (suture removal)
 Preputial cavity flushed daily (liquid antimicrobial)

When replacement is impossible and in chronic cases

Application of antibiotic ointment and bandaging every
other day (2 weeks),
 Other methods