Page 234 - Manual of Equine Field Surgery

230 FEMALE UROGENITAL SURGERIES

Cushing or Lembert pattern (Figure 42-4). continuous pattern ending at the center of the

Closure of the rectovaginal shelf and mucosal sur- shelf. The left side is closed in the same manner.

faces should extend to the cutaneous perineum. A Rectal and vaginal mucosa surfaces should not be

Caslick's procedure is then performed to appose penetrated.

the vulvar opening. Perineal body reconstruction begins at the

caudal edge of the newly formed rectovaginal

Semitransverse Closure Technique shelf and is continued caudally. The first suture

Small marker incisions are made at the ventral incorporates the caudal end of the newly formed

aspect of the perineal body along the left and right rectovaginal shelf and the right and left sides of

mucocutaneous junctions"; these markers will be the perineal body. The dorsal portion of the per-

used as the ventrocaudal points of the triangle inea! body is closed first with No. 2 absorbable

used to construct the perineal body. The scar suture using a Cushing pattern. Incorporation of

tissue mucosal junction along the rectovaginal the rectal, vaginal, or anal mucosa should be

shelf is incised longitudinally and divided in its avoided during closure. The remainder of the

entirety. Rectal and vaginal mucosae are under- perineal tissue is closed with No. 2-0 absorbable

mined approximately 7 to 10 cm from the recto- suture using a simple interrupted pattern.

vaginal shelf Beginning approximately 4 cm Caslick's procedure is performed to appose the

cranial to the external anal sphincter, a mucosal perineal skin and vulvar opening.

incision is made from the lateral edge of the rec-

tovaginal shelf ventrocaudally toward the original Two-Stage Repair

marker incision. A triangle-shaped section of

mucosa is excised; the exposed triangular section Aanes Technique

of submucosa will form the perineal body when The vaginal mucosa is inverted into the vaginal

sutured. The center of the rectovaginal shelf is lumen with No. 0 absorbable suture using a

grasped with Allis tissue forceps, pulling the shelf Connell or Lembert pattern. 6•7 This suture pattern

caudally to the cranial border of the proposed is continued caudally to reconstruct the cranial

perinea! body. The final configuration is in the half of the defect and then tied but not cut. Using

shape of a Y, with the base of the Y pointing No. 1 absorbable suture, purse-string sutures are

caudal. Beginning at the deepest corner on the used to close the rectovaginal shelf ( see Figure

right side, the rectovaginal shelf is reconstructed 42-3). Sutures are positioned approximately 1 cm

with No. 2 absorbable suture using a simple apart, avoiding the vaginal and rectal mucosa. If

an excessive amount of tension or dead space is

present, partial tightening of the purse-string

sutures along with sagittally oriented simple inter-

rupted sutures will help obliterate dead space

(Figure 42-5). 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 rectovaginal

shelf. Optionally, the rectal mucosa may be

inverted into the rectal lumen with No. 2-0

absorbable suture using a Cushing or Lembert

pattern. Closure of the rectovaginal shelf is con-

I tinued to the level of the cutaneous perineum.
Closure of the perineal body is performed 3 to

t 4 weeks after the first surgery if the rectovestibu-

lar shelf is completely healed. If dehiscence occurs

or a fistula is present, the first stage must be

repeated. Local anesthesia of the perineal body or

epidural anesthesia is used. Closure of the per-

inea! body is performed as described in the per-

Figure 42-4 The rectal mucosa is everted into tl1e inea! body reconstruction technique ( see Chapter

rectal lumen using a Cushing pattern. 40). A triangular section of the vestibular mucosa