Page 232 - Manual of Equine Field Surgery

CHAPTER 42

Third-Degree Perineal Laceration Repair

John C. Janicek

The preparation solution should be rinsed with
INDICATIONS sterile saline, not alcohol, as alcohol may cause

excessive irritation.

Dystocia, traumatic breeding, or conversion of a

rectovaginal fistula into a third-degree perineal

laceration for subsequent repair. PROCEDURE

One- and two-stage repair tech11iques are

EQUIPMENT described. A one-stage repair is preferred;

however, a two-stage repair should be performed

Long handled instruments and monofilament if excessive tension is present during surgery. No

absorbable suture materials are required. Self- distinct advantage or disadvantage exists between

retaining retractors (Balfour, modified Finochietto) techniques. Principles for all techniques include

and a good light source (floor lamps, headlamp, or initial creation of rectal and vaginal shelves,

fiberoptic lights) are useful but not required. minimal tissue tension, and maintaining a soft

manure consistency after surgery. All repair tech-

niques close the defect from cranial to caudal.

PREPARATION AND POSITIONING Modification of the techniques can be performed

based on surgeon preference,

Surgery is delayed for 4 to 6 weeks following the Towel clamps or retention sutures are posi-

laceration to allow wound contraction and inflam- tioned along the dorsolateral and ventrolateral

mation to subside. Delaying surgery for this period aspects of the laceration to provide exposure. The

allows the wound edges to strengthen and become cranial extent of the laceration is extended

clearly defined before repair is attempted. A gruel approximately 3 cm, creating a rectal and vaginal

or pasture diet is fed 3 to 5 days prior to surgery, shelf. Dissection is continued laterally and cau-

and the mare is fasted 1 day before surgery. dally along the scar tissue line into the submucosa

The mare is restrained standing in a stock, and until the tissue flaps created can be apposed on

surgery is performed following epidural anesthe- midline without tension (Figure 42-1). Both

sia, and sedation if necessary. 011ce anesthesia is mucosal surfaces are dissected 2 cm or more.

confirmed, the tail is wrapped and securely

retracted. Fecal material is removed from the One-Stage Repair

rectum and vagina. The perineal region is rinsed,

followed by cleansing of the rectal and vaginal Goetz Technique

lumens with a dilute povidone-iodine solution. Using No. 1 absorbable suture, a six-bite pattern

The perineal region is then aseptically prepared. is used to close the rectovaginal shelf.' The suture

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