Page 233 - Manual of Equine Field Surgery

Third-Degree Perinea! Laceration Repair 229

Figure 42-2 The rectovaginal shelf is closed with a

six-bite pattern. The pattern should begin and end in

Figure 42-1 Surgical dissection of a third-degree the vaginal lumen without penetrating the rectal

perinea! laceration prior to surgical repair. The recto- mucosa.

vaginal shelf is reflected with the proposed incision line

(dotted line) shown.
·-

-"-··- -c-, .... ~ ..

pattern begins within the vaginal lumen, allowing

the knot to be secured within the vaginal lumen

(Figure 42-2). Sutures are positioned approxi-

mately 1 cm apart; the suture pattern includes the

vaginal 1n11cosa but does not penetrate the rectal

mucosa. The vaginal mucosa is closed over the

newly created rectovaginal 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 rectovaginal

shelf and vaginal mucosa should extend to the

cutaneous perineum. Caslick's procedure is then

performed to appose the vulvar opening.

Modified Goetz Technique

The vaginal mucosa is inverted into the vaginal

lumen with No. 0 absorbable suture using a Figure 42-3 The vaginal mucosa is inverted into the

Connell or Lembert pattem.i" This suture pattern vaginal lumen using a Connell pattern and the recto-

is continued caudally to reconstruct the cranial vaginal shelf is closed using a purse-string pattern,

half of the defect and then tied but not cut. Using

No. 1 absorbable suture, purse-string sutures are shelf is reconstructed, closure of the vaginal

used to close the rectovaginal shelf (Figure 42-3). mucosa is completed, followed by closure of the

Sutures are positioned approximately 1 cm apart remaining caudal half of the rectovaginal shelf.

and should not pass through the vaginal or rectal The rectal mucosa is everted into the rectal

mucosa. Once the cranial half of the rectovaginal lumen with No. 0 absorbable suture using a