Page 505 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

480 CHAPTER 2

VetBooks.ir opportunity to reconstruct a strong shelf between of the injury, but it is guarded to fair for return to
breeding soundness. Fistulae rarely recur at subse-
the rectum and the vagina. The second repair
method involves splitting the perineum transversely
between the anus and the dorsal vulva, and continu- quent foalings.
ing this to and beyond the fistula for 3–5 cm. Two POST-FOALING PERINEAL BRUISING
holes are thus created, one dorsally into the rectum AND VULVAR HAEMATOMA
and the other ventrally into the vagina. These fistu-
lae are then closed with everting suture patterns and Definition/overview
the dissected dead space and perineum are sutured Haematomas in the vaginal wall and vulval lips are
closed. Other methods include fistula repair follow- common, especially in primiparous mares, where
ing a transrectal or transvaginal approach, which has large foals have been delivered and in cases of dys-
the disadvantage of a more limited exposure. tocia, particularly where large amounts of manipula-
The mare can be re-bred by AI or natural cover- tion have been necessary. Considerable oedema may
ing as for third-degree tears. Complications include accompany the bleeding. In some cases swelling of
total or partial wound breakdown in the rectal and/ the perineal area adjacent to the vulva may be seen
or vaginal layers and, quite commonly, some peri- and this can be painful to palpate. In severe cases
neal dehiscence with secondary intention healing. there may be caudal vaginal or vulval lacerations
Infected wounds in the perineum can be treated by (Figs. 2.86–2.88). Complications of these cases can
drainage and lavage and often resolve. Postoperative include severe vaginitis, fibrosis and abscessation.
constipation and straining are a continual concern Treatment should include faecal softeners to ease
and best resolved with careful dietary management. the passage of faeces through a swollen and painful
perineum/pelvic canal, broad-spectrum antibiotics,
Prognosis tetanus prophylaxis, NSAIDs and emollient creams.
Small fistulae may heal spontaneously and carry a Most of the swelling and haematoma resolves
fair prognosis. Where surgical repair is necessary, uneventfully, but rarely haematomas in the vulva and
the prognosis depends on the extent and severity vagina may require drainage 7–10 days after foaling.

2.86 2.87 2.88

Figs. 2.86–2.88 (2.86) A Thoroughbred mare that suffered perineal, vulval and vaginal bruising and trauma,
following major dystocia. (2.87) After retraction of the damaged vulval lips it is clear that there is damage to the
vestibule and vagina, while the cervix is still dilated and there is a view directly into the damaged uterus. (2.88). The
vulval and vaginal damage is being lightly debrided with sharp scissors after thorough washing with antiseptic solution.