Page 223 - Manual of Equine Field Surgery

CHAPTER 40

Perineal Body Reconstruction (Episioplasty)

John C. Janicek

INDICATION tissue required to develop a dorsal commissure

that will provide an adequate vaginal seal. The

length required is typically 4 to 6 cm. The incision
Pneumovagina or persistent endometritis follow- is then extended dorsocranially until the cranial

ing Caslick's procedure.
portion terminates on the dorsal midline at the

vestibulovaginal junction (Figure 40-1). The tri-

EQUIPMENT angular mucosa! flaps are then resected from both

sides of the vestibule. The resultant exposed sub-

No special equipment is required. mucosa forms a right-angled triangle with the

right angle located along the dorsal commissure

of the vulva1 (Figure 40-2).

PREPARATION AND POSITIONING Closure of the ventral vestibular mucosal

margins is performed cranial to caudal with No. 2-

The mare is restrained standing in a stock, and the O absorbable suture iJ.1 a simple continuous pattern/

procedure is performed with either epidural or (Figure 40-3). Deeper submucosal tissues are

local perinea! body anesthesia, and sedation if apposed with No. 2-0 absorbable suture using a

necessary. Once anesthesia is confirmed, the tail simple interrupted pattern. Caslick's procedure is

is wrapped and securely retracted. Fecal material is performed to appose the vulvar opening (Figure

removed from the rectum. The perineal region is 40-4).

then rinsed and aseptically prepared. Sterile saline

is used instead of alcohol to remove antiseptic

I
soaps, because alcohol may cause excessive irrita- POSTOPERATVE CARE

tion.

Postoperative Care

Exercise Restridions: Small-paddock turnout
PROCEDURE should be maintained for 14 days.

Medications: Broad-spectrum antibiotics are

Vulvar retraction is maintained with towel clamps administered for 7 to 1 O days. A nonsteroidal anti-

or stay sutures positioned lateral to the dorsal inflammatory agent is administered for 3 to 5

vulvar commissure. In this procedure, triangular days.

areas of mucosa are removed from the perinea! Suture Removal: Caslick's sutures are removed

body. An incision is made along the vulvar muco- l O to 14 days after surgery.

cutaneous margin of both labiae beginning at the Other: Sexual rest for 4 to 6 weeks is recom-

dorsal commissure, extending to the desired mended. Prior to foaling (3 to 5 days), an epi-

ventral limit.' The ventral limit of the incision is siotoiliy should be performed to prevent perinea!
damage during parturition.
subjectively chosen by determining the amount of

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