Читать книгу Bovine Reproduction - Группа авторов - Страница 315

The surgical technique for repair that is advocated by the authors is the circumcision or “reefing” technique. The bull must be tabled and is often anesthetized, but this procedure can be performed with regional analgesia and heavy sedation. Prior to surgery, the bull is fasted for 36–48 hours and water withheld overnight. The bull is placed in right lateral recumbency and the hair of the sheath is clipped. The penis is extended and maintained in extension with towel forceps that engage the apical ligament. The penis and prepuce are prepped (NO alcohol) and draped. A tourniquet is applied utilizing 1‐inch Penrose tubing, proximal to the area to be transected. The amount of prepuce to be resected is then determined (the remaining prepuce must be a minimum length of 1.5× the free portion). Two marker sutures are placed on what will be the adjoining edges of the suture line to ensure that tissues are returned in the proper alignment. Two circumferential incisions are made with these representing the edges of the epithelial tissue to be removed. These incisions are then joined with a longitudinal incision. The incisions are to be very superficial so that with careful, sharp dissection, underlying tissue, blood vessels, and lymphatics will be spared. The area of fibrosis should be included in the tissue removed. Following dissection and tourniquet removal (the tourniquet can be maintained safely for up to 1 hour); hemorrhage is controlled by vessel ligation and/or cautery. When hemostasis is achieved, lavage the area with a warm solution of sterile saline with 50 ml Betadine Prep Solution added per liter of saline. The edges are sutured with a simple continuous subcuticular pattern using your choice of 2–0 absorbable suture material.

Do not use a single continuous pattern, but instead end the pattern and restart in three stages to avoid a constrictive (purse‐string) effect. Do not close dead space. This can then be followed with a row of staples or closed with your choice of suture pattern with 0 chromic gut. Then suture in place Penrose tubing over the end of the penis. An antibiotic ointment is applied to the wound and, placing the free end of the Penrose tubing into a 6‐ to 10‐inch rigid tube, the penis and prepuce are carefully returned into the sheath and bandaged. The bandage can stay on as long as a week; the staples can be removed in two weeks. A support wrap (Bull diaper) or sling as previously described can be employed to protect the bandage and prevent pendulant swelling (Figures 19.29–19.39).

Figure 19.29 Penis extended in preparation for circumcision. Note loose excessive prepuce.

Figure 19.30 Determination of length of free portion of penis.

Figure 19.31 Proximal end of free portion indicated by surgeon’s left forefinger.

Figure 19.32 Length of excess prepuce measured from end of sheath (surgeon's small finger) to preputial ring (surgeon's thumb).

Figure 19.33 (a) Circumferential and longitudinal skin incisions in preputial epithelium. Note Proximally placed Penrose drain which serves as tourniquet. (b) Schematic of circumferential and longitudinal skin incisions for circumcision of a bull.

Figure 19.34 Dissection and removal of preputial skin and scar tissue.

Figure 19.35 Subcutaneous closure with continuous pattern. Note this closure performed in thirds.

Figure 19.36 Preputial epithelium suture closure.

Figure 19.37 Preputial epithelium closed with staples.

Figure 19.38 Penrose drain sutured over free portion of penis for urine drainage.

Figure 19.39 Prepuce bandaged with Penrose drain within rigid tube.