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3 Tail Wrap and Preparation/Washing of the Perineum

John J. Dascanio

School of Veterinary Medicine, Texas Tech University, USA

Introduction

The mare’s perineum should be washed prior to internal reproductive procedures and in preparation for foaling, to remove gross debris and to reduce bacterial numbers. In addition, the perineum is washed prior to perineal surgery such as the placement of a Caslick suture (vulvoplasty). The perineum is also washed as part of the minimum contamination breeding technique to reduce contamination of the uterus during natural cover or artificial insemination.

Equipment and Supplies

Tail wrap, tail rope, non‐irritant soap, roll cotton, stainless steel bucket, plastic bag/bucket liner, paper towels, examination gloves.

Placement of a Tail Wrap

 A tail wrap should be placed prior to washing of the perineum. This may be a reusable neoprene wrap, Velcro® wrap, gauze wrap, flexible elastic wrap (Vetrap™), or an obstetrical sleeve.

 A reusable neoprene Velcro® wrap is cost effective and quick in application. It should be washed regularly with a disinfectant soap and dried before reuse. This is especially important if the wrap is used with different mare populations. The prevention of disease transmission is difficult with the reuse of this wrap without sanitation; thus, if there is a suspicion of such, a disposable tail wrap should be used.

 A gauze wrap is placed on the tail using one of two techniques. With both techniques the wrap goes from the base of the tail to a level just below the ventral commissure of the vulva. Technique one is to start at the top of the tail and with every circumferential wrap, flip some tail hairs upward so that they become trapped between successive layers (Figure 3.1). This prevents the tail wrap from slipping down the tail. This tail wrap must be unwound to remove. The second type of gauze wrap starts at about the level of the ventral vulvar commissure (Figure 3.2). A small piece of gauze is left hanging and the wrap placed around the tail, moving upward to the tail base. Hair should not be included between layers, with each layer overlapping the previous slightly. Once at the tail base, the gauze is twisted 360 degrees so that the twisted part is on the dorsal tail, while the ventral aspect of the wrap remains flat and untwisted. This allows the twist to bite into the tail hair on the dorsum, preventing slippage of the wrap, while the flat underneath aspect prevents blood occlusion. The wrap is continued downward and is twisted upon every circumferential wrap ending at the point where the wrap began. The small hanging piece of gauze from the beginning is tied to the remaining wrap to prevent the wrap from coming loose. This wrap may be pulled from the top to slide down the tail and removed without having to unwind the wrap when the procedure is completed. This wrap acts like a Chinese finger trap.Figure 3.1 Gauze tail wrap with tail hairs flipped up to prevent sliding of the wrap down the tail.Figure 3.2 Gauze tail wrap twisted 360 degrees on the dorsum of the tail while the ventral aspect is wide.Figure 3.3 Elastic tail wrap encompassing the entire tail.

 If an obstetrical sleeve is used for a tail wrap, the tail is placed entirely inside the sleeve. The sleeve may be split at the tail base and tied together to close the sleeve around the tail base, or elastic adhesive tape or an elastic band and clamp may be used to wrap around the sleeve at the tail base to secure it. This type of tail wrap is useful for mares with diarrhea to prevent soiling of the tail hairs.

 If a flexible elastic wrap is used such as Vetrap™, the wrap may either be used to wrap the entire tail or the upper portion (Figure 3.3). The entire tail is wrapped for a dystocia or a fetotomy to prevent tail hairs from interfering with the procedure. To place the entire tail in a wrap, fold the tail hairs so that the hairs do not extend beyond the tail stump. Wrap the elastic wrap around the tail/tail hairs so that no hair is visible along the entire tail length. This in effect creates a “club” with the tail wrapped completely.

 After wrapping, the tail is held to the side so that the perineum can be washed or the tail is tied to the mare (Figure 3.4).

 Alternative tail wrap techniques include use of a sock held in place by 5 cm (2 inch) medical tape (Figure 3.5) or a plastic bag (75 × 25 cm (30 × 10 inches)) held in place by 2.5 cm (1 inch) rubber tubing and a clamp (Figure 3.6). The wrapped tail can be held out of the way by using an elastic cord (Figure 3.7) or being tied to the mare as previously described.

Figure 3.4 Tail wrap tied to the mare with quick release knots.

Figure 3.5 Tail wrap using a sock and secured with medical tape.

Figure 3.6 Tail wrap using a plastic bag and secured with rubber tubing and a clamp. An extra clamp is shown above the tail.

Figure 3.7 Wrapped tail held out of the way using an elastic cord.

Washing Perineum Technique

 Feces should be evacuated from the rectum prior to washing the perineum.

 The perineum is usually washed using one of two techniques: a bucket technique or a water hose technique.

 The bucket technique requires a clean bucket with a disposable liner. A small clean garbage bag works as a liner (Figure 3.8). The liner can be filled with warm water and the top tied to prevent spillage when carrying or to prevent dirt and dust from blowing into the water in a barn environment (Figure 3.9). When ready to use, simply open the plastic bag over the bucket. This also provides some biosecurity, with a new disposable liner used between horses or farms. The classic “clean hand, dirty hand” technique is used to wash the mare. Handfuls of loose cotton are placed into the bucket of water. The person washing the mare wears disposable examination gloves. The “clean” hand retrieves a piece of cotton and holds it away from the bucket over the “dirty” hand and allows the water to drip over the “dirty” hand. The “dirty” hand is massaged under the water flow to clean it of any dirt or debris. The cotton piece is then dropped from the “clean” hand into the “dirty” hand. The “dirty” hand is then used to wash the mare’s perineum using concentric circles going outward from the vulva. A mild detergent may be used to help remove smegma and organic debris. The perineum is successively washed until the cotton washing the vulva appears clean after performing the wash. Typically three to four wash/rinse cycles are needed for the average mare. It is important to insure that all soap is rinsed from the perineum.

Figure 3.8 Bucket with liner to provide clean water for washing mares. All materials are disposed of between horses.

Figure 3.9 Bucket with liner closed to prevent dirt from contaminating water or to prevent water spillage when walking quickly with the bucket.

 The water hose technique is less labor intensive and involves fewer materials than the bucket technique and works well where there are stationary horse stocks. A gentle stream of water or a shower‐type water nozzle should be used. Disposable examination gloves are placed on the hands and the perineum is rinsed with water to remove any gross debris. A mild detergent soap is placed directly on the labia or is placed on the back of the hand. The back of the hand and knuckles are used to vigorously scrub the perineum, using concentric circles going outward from the vulva (Figure 3.10). The gloved hand used to wash the mare is rinsed with the water hose. When rinsing the perineum with the water hose, the back of the hand/fingers may be used to help remove soap residue (Figure 3.11). The perineum is scrubbed until clean, usually involving three to four wash/rinse cycles.

Figure 3.10 Washing the perineum with a gloved hand.

Figure 3.11 Rinsing the perineum with a gloved hand and a gentle shower spray. Note Velcro^®/neoprene tail wrap.

 Once the mare has been cleaned adequately, a final wetted cotton piece is squeezed to remove most of the water and the lips of the vulva are separated. The cotton piece is then swiped from the dorsal to the ventral commissure just inside the mucosa to remove any debris that wicked in between the labia. This is done usually only once so as to avoid trauma to the mucosa. The perineum is dried with a clean paper towel in the same outward concentric pattern used to wash the mare.

Interpretation

 When washing the mare, care should be taken so that water running down the back legs does not cause the mare to kick outward.

 A disinfectant soap should not be routinely used in order to prevent killing normal skin flora and to prevent overgrowth of a pathogenic bacteria. A disinfectant soap may be used for surgical procedures.

 The perineum should be scrubbed from the labia to 15–30 cm outward from the labia so that if the mare moves when entering the vulva with a gloved arm, the gloved arm will remain clean.