Bovine Surgery and Lameness (Second Edition)
Bovine Surgery and Lameness (Second Edition)
Bovine Surgery and Lameness (Second Edition)
Second Edition
A. David Weaver
BSc, Dr med vet, PhD, FRCVS, Dr hc (Warsaw)
Professor emeritus, College of Veterinary Medicine,
University of Missouri, USA, and Bearsden, Glasgow, Scotland
Adrian Steiner
Dr med vet, FVH, MS, Dr habil, Dipl ECVS, Dipl ECBHM
Professor and Head, Clinic for Ruminants, Vetsuisse-Faculty of Berne,
Switzerland
© 2005 David Weaver, Adrian Steiner and Guy St Jean
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First published as Bovine Surgery and Lameness in 1986 by Blackwell Scientific
Publications
Library of Congress Cataloging-in-Publication Data
Weaver, A. David (Anthony David)
Bovine surgery and lameness / A. David Weaver, Guy St. Jean, Adrian Steiner. – 2nd ed.
p. cm.
Includes bibliographical references and index.
ISBN-10: 1-4051-2382-6 (pbk. : alk. paper)
ISBN-13: 978-1-4051-2382-2 (pbk. : alk. paper)
1. Cattle–Surgery. 2. Lameness in cattle. I. St. Jean, Guy. II. Steiner, Adrian,
1959– III. Title.
SF961.W43 2005
636.089′7–dc22
2004028333
ISBN 10: 1-4051-2382-6
ISBN 13: 978-14051-2382-2
A catalogue record for this title is available from the British Library
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Contents
Appendices
1 Further Reading 259
2 Abbreviations 260
3 Useful Addresses 262
Index 269
Preface to First Edition
This book aims to give the nuts and bolts of practical bovine surgery and
lameness.
The text is directed to veterinary students in the clinical years of their
undergraduate courses, and to recent and older veterinarians, who experi-
ence a limited amount of cattle surgical material. In the interests of com-
pression and simplicity, a single procedure is described in some detail, while
the alternatives, known to be equally good in the hands of others, are briefly
listed. No apology is made for such dogmatism.
The text includes frequent reference to specific types and sizes of instru-
ments and suture materials. In view of the current move to the metric system,
albeit late in the Anglo-American world, all figures are metric, but a com-
parative scale is included.
All surgery presents a series of challenges, and this accounts for the
popularity of the discipline in both the veterinary and medical professions.
The challenges in bovine surgery differ from those met by the companion
animal surgeon. The first is the economic question: is surgery economically
justified? The balance of a judgement to perform a caesarean section on a
heifer with dystocia rather than to salvage the animal may be a fine one. This
is rarely so in the companion animal field. Humane considerations often
complicate an otherwise simple problem.
Other challenges include the anatomical knowledge pertinent to the proce-
dure, the method of restraint and analgesia or anaesthesia, the demands of
manual dexterity, and the physical stress imposed on patient and surgeon
alike, when surgery must be performed in a sub-optimal environment, which
may be the corner of a field or a dark spot in a dusty cowshed.
The inevitable lack of experience in bovine surgery of a young veterinary
graduate may persist as a result of a certain apathy among colleagues in
the practice group. This apathy is reflected in the difficulties of maintaining
equipment necessary for emergency surgery, and results in impatience at
the overall time required to complete a bovine operation. The axiom ‘time
is money’ applies as much to the bovine surgeon as to anyone and, since
proper instrumentation, asepsis, effective anaesthesia and basic techniques
are the keystones to effective craftsmanship, these points are discussed in
the first section.
vi Preface to First Edition
Succeeding chapters logically pass from the head and neck to the abdomen,
thence to the female urinogenital system and teat surgery, the male urino-
genital apparatus, and finally to lameness. No attempt can be made to treat a
subject in depth. The further reading list is similarly selected purely as a basic
literature guide.
The reader will often have to consider ethical implications of proposed pro-
phylactic or curative surgery. Animal welfare considerations are becoming
increasingly important in many countries. Is castration justified? Is it justified
in older cattle, either on humane, economic or management grounds? The
relevant veterinary literature is sparse and the conclusions are conflicting.
Responsibility rests with the veterinarian.
Why does a farm experience an ‘epidemic’ of left abomasal displacement
cases? The veterinarian may search for further advice on prophylaxis. Such
an investigation will often involve other disciplines. A multi-disciplinary
approach is particularly needed in herd lameness problems, and the check
lists (see pp. 236–238) should stimulate objective recording of herd data
and take the emphasis away from repetitive back-breaking treatment of the
individual cow.
Serving as a prophylactic, diagnostic and therapeutic instrument, bovine
surgery therefore fits into the concept of a herd health programme.
A. David Weaver
Columbia, September 1985
Preface to Second Edition
The ever increasing risk over the last 20 years of litigation involving the
veterinarian has resulted in more emphasis on the avoidance of potential
disasters such as accidental injury to the animal or attendants, or unexpected
sequelae to standard surgical procedures. The farm manager or attendant
should always be informed beforehand of possible problems, and, we believe,
could well occasionally be shown relevant sections of our text on the farm. No
veterinarian should undertake any intervention when lacking the necessary
confidence or knowledge. We believe bovine surgeons must understand
their important role in the worldwide cattle industry today.
The authors trust that this pocketbook will again provide a handy
vademecum and a valuable and practical tool in daily practice.
Permission again to reproduce illustrations from the first edition was gra-
ciously given by several authors and publishers (Dyce, Pavaux, Cox, Smart),
while new illustrations came from several sources as below.
Figs. 1.7, 2.5, 3.2, 3.22 Dr. K.M. Dyce, Edinburgh and W.B. Saunders
‘Essentials of Bovine Anatomy’, 1971 by Dyce and Wensing
Figs. 2.4, 2.9, 3.1, 3.4, 3.5 Professor Claude Pavaux, Toulouse, and Maloine
s.a. editeur from‘Colour Atlas of Bovine Anatomy: Splanchnology’ 1982
Fig. 3.15, Dr. John Cox, Liverpool, and Liverpool University Press ‘Surgery of
the Reproductive Tract in Large Animals’ 1981
Fig. 3.24, Dr. M.E. Smart, Saskatoon and Veterinary Learning Systems,
Yardley, PA, USA from‘Compendium of Continuing Education for the Practicing
Veterinarian’ 7, S327, 1985
Fig. 3.17, Dr. H. Kümper, Giessen and Blackwell Science from ‘Innere Medizin
und Chirurgie des Rindes’ 4e 2002 edited by G. Dirksen, H-D. Gründer and
M. Stöber fig. 6.125)
Fig. 4.6, Dr. R.S. Youngquist, Columbia, Missouri and W.B. Saunders from
‘Current Therapy in Large Animal Theriogenology’ 1997 (fig. 57.2)
Fig. 7.12, Dr. M. Steenhaut, Gent, and Blackwell Science from ‘Innere Medizin
und Chirurgie des Rindes’ 4e 2002 edited by G. Dirkson, H-D. Gründer and
M. Stöber (fig. 9.159)
Jan Huckin, Newbury, produced many new illustrations from rough sketches
by the first author, as did also Don Connor in Missouri. Many others come
from the hand of Eva Steiner. John Sprout, Castle Douglas, not only com-
mented usefully on the entire manuscript but also supplied some excellent
sketches (Figs. 1.14, 1.15 and 2.2)
x Acknowledgements
The authors have made every effort to ensure that drugs, their dosage
regimes and withdrawal periods are accurate at the time of publication.
Nevertheless, readers should check the product information provided by the
manufacturer of each drug before its use or prescription.
Drug authorisation by regulatory authorities varies from country to coun-
try, and drug withdrawal times, dependent on maximum residue limits
(MRL), which are derived from residue depletion studies, can also vary from a
parent (proprietary) product to a generic equivalent. Withdrawal times vary
within member states of the EU, North America and elsewhere in the world
(shown in Table 1.15).
The reader should exercise individual judgement in coming to a clinical
decision on drug usage, bearing in mind professional skill and experi-
ence, and should at all times remain within the regulatory framework of the
country.
Bovine Surgery and Lameness, Second Edition
A. David Weaver, Guy St. Jean, Adrian Steiner
Copyright © 2005 David Weaver, Adrian Steiner and Guy St Jean
CHAPTER 1
1.1 Instrumentation
Instruments should be maintained in good condition and, for common proce-
dures, in sterile surgical packs (caesarean section, laparotomy, teat surgery,
orthopedic surgery).
Sterilisation
Instruments should preferably be sterilised by one of the first two methods
listed below:
*high density
†
low density
Autoclaving + + + + +
Gas sterilisation + + + + +
Chemical antiseptics + — + (+) +
Boiling + — + + +
• embryotomy finger knife (for incision into uterine wall which cannot be
brought near body wall)
Also needed are suture needles, which should include two each of the follow-
ing types and sizes (see Figure 1.2):
1.2 Asepsis
Bovine surgery involving regions where adequate skin preparation is feasible
(i.e. with avoidable microbial contamination of tissues or sterile materials)
should be performed under aseptic conditions. Instruments and cloths should
be sterile.
Preparation of operative field (e.g. flank):
Table 1.4(a) Equivalent gauges for suture materials (metric gauge in this text).
Values for absorbable suture materials (e.g. multifilament polyglactin 910 [Vicryl] catgut and
collagen) are given in brackets
Multifilament polyglycolic acid or PGA Dexon, is also classified as non-absorbable in the above
table
BP = British Pharmacopoeia USP = United States Pharmacopoeia
Table 1.4(b) Equivalent gauges for hypodermic needles (metric gauge in this text).
Metric mm BWG/G
external diameter UK /North America
2.10 14
1.80 15
1.65 16
1.45 17
1.25 18
1.10 19
0.90 20
0.80 21
Metric internal diameter is 0.05–0.1 mm less than the external diameter above
Suture materials
Non-absorbable suture materials:
Discussion
Selection of suture material should be based on the known biological and
physical properties of the suture, wound environment and tissue response to
the suture.
Monofilament nylon remains encapsulated in body tissues when buried,
but the inflammatory reaction is minimal. It has great size-to-strength ratio
and tensile strength. It is somewhat stiff and is therefore not particularly
easily handled, an important point when operating in sub-optimal conditions
of poor light and awkward corners, where the surgeon is bent down. Knot
security is only fair.
Multifilament polyamide polymer, encased in an outer tubular sheath
(pseudomonofilament), has good strength and provokes little tissue reaction
unless the outer sheath is broken, but it loses strength when autoclaved. It is
therefore usually drawn from a sterile spool as and when required. It is very
easily handled.
Surgical steel has the greatest tensile strength of all sutures, and retains
strength when implanted. It has the greatest knot security and creates little
or no inflammatory reaction. Surgical steel however tends to cut tissue, has
poor handling and cannot withstand repeated bending without breaking. It
is sometimes used in tissues that heal slowly (e.g. infected linea alba).
Of the six absorbable materials listed, chromic catgut is still commonly
used, but has been replaced by synthetic absorbable material in cattle prac-
tice. Catgut has relatively good handling characteristics, but also the dis-
advantages of relatively rapid loss of strength in well vascularised sites (50%
in the first week) and poor knot security (tendency to unwrap and loosen
when wet). The potential minute risk of the transfer of infectious prion
material into food-producing animals (e.g. cattle) and thence into the human
Table 1.5 Comparative qualities (graded undesirable to desirable, + to +++), of nine selected suture materials for cattle.
Generic name Origin Tensile Knot Tissue Resistance Absorption without Cost
(trade name) strength security Handling reaction to infection inflammation after
tissue repair
Absorbable
Chromic catgut collagen (+) + ++ +++ + + low
Coated braided PGA glycolic acid polymer, ++(+) ++ ++(+) ++ ++ ++ high
(PGS), (Dexon Plus®2) coated surfactant
Polydioxanone polymer of +++ ++ ++ + +++ + high
monofilament (PDS1) paradioxanone
Coated braided glycolic-lactic acid ++(+) ++ + ++ ++ ++ high
Polyglactin 910 copolymer
(coated Vicryl®1)
Monofilament copolymer of glycolic +++ ++ + +++ + high
polyglyconate acid & trimethylene
(Maxon®2)
Non-absorbable
Polypropylene polymerised polyolefin +++ (+) +(+) (+) +++ NA low
monofilament (Prolene®, hydrocarbons
Surgelene®, Prodek®)
Surgical steel alloy of iron +++ +++ + + +++ NA low
Monofilament nylon polyamide filament ++(+) + + + + NA low
(Dermalon®, Ethilon®,
Surgidek®)
Polyfilament polyamide polymer ++(+) ++ +++ + ++ NA low
polyamide polymer
(Suprylon®, Vetafil®,
General considerations and anaesthesia 9
Braunamid®)
NA = not applicable
1Ethicon 2Davis and Geck
10 Chapter 1
food chain has led to a ban on the use of chromic catgut in some countries
(vCJD risk).
Multifilament polyglycolic acid (PGA) has greater strength which is lost
evenly, provoking much less tissue reaction than chromic catgut. PGA is
non-antigenic, has a low coefficient of friction and therefore requires multiple
throws to improve knot security, but is easily handled.
Monofilament polydioxanone (PDS) is very strong, retaining its strength
for many weeks (58% at four weeks), is easily handled, has good knot secu-
rity, and has the sole disadvantage of provoking an initial tissue reaction
which recedes during suture absorption.
‘Soft’ catgut is undoubtedly the most easily handled absorbable material
for delicate bowel anastomoses, its quality even exceeding that of PGA, but
it is not yet widely available. Plain or soft catgut is absorbed quickly and
maintains its strength for a short time. In coming years PDS and PGA are
likely to slowly replace chromic catgut, which will retain its place as a general
purpose material. Vicryl® in its coated form is very easy to handle, has
minimal tissue reaction and tissue drag. It is stable in contaminated wounds.
Polyglyconate monofilament (Maxon™) has three times the strength of
Vicryl® at day 21 of wound healing.
Suture needles
Suturing can only be performed efficiently with needles which are rust-free,
sharp, and strong enough for insertion through the specific tissue. A selection
of needles may be conveniently maintained on a rack in a metallic sterile
container.
Discussion
Suture patterns are discussed under the specific procedures. Skin under
considerable or potential tension at certain sites, such as the vulval lips and
peri-anal region (e.g. following replacement of prolapsed uterus, vagina or
rectum), is usually sutured with sterile woven nylon tape 3–5 mm diameter.
Introduction
Assessment should include numerous factors apart from the physical condi-
tion of the subject:
Laboratory tests
Under farm practice conditions laboratory tests may not be performed, but
the major parameters very simply estimated with minimal apparatus are:
1.5 Restraint
Introduction
Restraint is necessary for:
Techniques
Physical restraint by stockman includes:
• halter
• nose grip (fingers or nose tongs)
• tail elevation
• skin grip of crural fold
Rope restraint includes:
• hock twitch
• hindlimb elevation by rope above hock and round an overhead beam
• Reuff’s method of casting or sidelines
Many forms of cattle crush or squeeze chute are available with excellent
head restraint, which are suitable for surgery of the head and cranial neck
(e.g. tracheotomy) and of the perineum. (An essential feature of these crushes
12 Chapter 1
Haematology
Erythrocytes ×1012/l 7.0 (5–10)
Haemoglobin g/dl 11.0 (8–15)
PCV (haematocrit) 1/l 35.0 28–38
Fibrinogen g/l 4.0 (2–7)
Leucocytes ×109/l 7.0 (4–12)
Neutrophils (non-segmented bands) ×109/l 0.02 (0.5%) 0–1.12 (0–2%)
Neutrophils (segmented mature) ×109/l 2.0 (28%) 0.6–4 (25–48%)
Lymphocytes ×109/l 4.5 (58%) 2.5–7.5 (45–75%)
Monocytes ×109/l 0.4 (4%) 0.02–0.8 (2–7%)
Eosinophils ×109/l 0.65 (9%) 0–2.4 (0–20%)
Basophils ×109/l 0.05 (0.5%) 0–0.2 (0–2%)
Neutrophil: lymphocyte ratio — 0.45:1 —
Plasma biochemistry
Urea mmol/l 4.2 2.0–6.6
Creatinine mmol/l 100 44–165
Calcium mmol/l 2.5 2.0–3.4
Inorganic phosphate mmol/l 1.7 1.2–2.3
Sodium mmol/l 139 132–150
Potassium mmol/l 4.3 3.6–5.8
Chloride mmol/l 102 90–110
Magnesium mmol/l 1.02 0.7–1.2
Total protein g/l 67 51–91
Albumin g/l 34 21–36
Globulin g/l 43 30–55
Glucose mmol/l 2.5 2.0–3.2
Alkaline phosphatase iu/l 24 20–30
AST SGOT iu/l 40 20–100
ALT SGPT iu/l 10 4–50
Lactate deydrogenase (LDH) iu/l 700 600–850
Bilirubin mmol/l 4.1 0–6.5
Cholesterol mmol/l 2.6 1.0–3.0
Creatine phosphokinase mmol/l 3.0 0–50
The above values refer to healthy adult (> 3 years old) cattle, and have been compiled from various
sources. Interpretation of possible deviations from the above ranges should consider variations
due to the laboratory technique, breed, lactational and nutritional status, and should always be
related to the presenting signs and symptoms of the individual or group. Units are given as SI units
or chutes is the ability to release the head rapidly should the animal collapse.)
Many are unsuitable for flank laparotomy, caesarean sections or rumeno-
tomy, however manufacturers will modify sides of crushes (lowering hori-
zontal bar and with a greater space between vertical bars) to improve access
to the paralumbar fossa. A veterinary practice may find it advantageous to
have such a crush available for surgery on the practice premises or to be
General considerations and anaesthesia 13
transported to the farm. Many crushes have poor facilities for the elevation
and restraint of hind- or forelimbs for clinical examination and digital
surgery. An exception is the Wopa crush, which is excellent for teat and feet
surgery. Suitable crushes may easily be made on the farm and tilted either by
manual means or by power.
The use of a crush/squeeze chute should never replace adequate analgesia
for surgical procedures.
Introduction
Premedication and sedation (see Table 1.7) have five aims:
Advantages
Very useful analgesic and sedative. Xylazine also causes muscle relaxation.
Disadvantages
Causes ruminal stasis, increases salivation, and effects of higher dose rate are
somewhat unpredictable as animal may or may not become recumbent.
Xylazine is unsuitable as the sole agent for minor surgery when more than a
Table 1.7 Activity and dosage of selected analgesic, anti-inflammatory and sedative drugs in cattle.
14 Chapter 1
Butylscopolamine bromide/metamizole
(Buscopan® Boehringer) + + — 5 ml/100 kg2
Meloxicam
(Metacam® Boehringer) + + — 0.51 0.5
Carprofen
(Rimadyl® LA soln, Pfizer) + + — 1.41 1.4
Xylazine
(Rompun® 2% Bayer) + — + 0.05–0.3 0.03–0.1*
Diazepam (Valium®)* + — + 0.5–1.0 0.2–0.5
Flunixin meglumine
(Finadyne®, Banamine®Schering-Plough) + + — — 2.2
Acetylpromazine*
(ACP® Novartis) — — + 0.03–0.1 0.03–0.1
*not authorised for use in cattle in UK and EU, may only be given ‘off label’
1by s.c. route, not i.v.
2
not authorised in lactating cattle
General considerations and anaesthesia 15
Chloral hydrate
Long established sedative is given orally (30–60 g as 5% solution but bull
requires 120–160 g) or i.v. (5–6 g/50 kg bodyweight as 5% solution). The
solution is irritant, and perivascular injection is likely to lead to necrosis and
severe skin slough. Infusion (total volume about 1 litre for adult cow) should
be made slowly via i.v. catheter over a minimal 5 minute period, since narco-
sis continues to deepen after completion of injection. Chloral hydrate is not an
analgesic. Concentrations required to produce general anaesthesia cause
severe, possibly fatal respiratory and circulatory depression.
Atropine sulphate
Drug reduces quantity and increases viscosity of saliva. Premedicant dose in
adult cow is 60 mg s.c.
16 Chapter 1
Table 1.8 Properties of four local analgesic drugs (all hydrochloride salts).*
Main indications
surface analgesia % 2–10 NS NS 0.25
infiltration % 0.5–1 2–3 0.25 0.25–0.5
Nerve block % 2–3 3–5 0.5 0.5
Epidural block % 2–3 3–5 0.5–0.75 0.5
Rate of diffusion fast slow fast slow
Duration of action 60–90 mins < 60 min ⬄8 hours ⬄8 hours
Analgesic potency + + + +++
Toxicity + + + ++
Tissue irritation low low low low
Stability at boiling point ? good ? ?
Cost (low → high:
+ → +++) ++ + +++ ++
Other properties good safety vasodilator, — decomposes
margin, no used with if mixed with
vasodilator adrenalin alkalis
* several of these drugs are not authorised or licensed for use in certain countries, e.g. only procaine
is authorised in UK for use in cattle (unless used in cattle not intended for human consumption)
NS = not suitable
Lignocaine
Lignocaine (Lidocaine/USP) has largely replaced procaine as it has the
advantage of:
• extreme stability
• more rapid diffusion
• longer duration of action
• useful surface analgesic activity on mucous membranes and cornea
It is however no longer authorised for cattle in the UK and EU states, as it has
no MRL.
Proprietary names include Lignodrin 2% (Vétoquinol), Lignol (Arnolds),
Locaine 2%, (Animalcare), Locovetic (Bimeda).
Toxic effects are rarely encountered (e.g. inadvertent intravascular injec-
tion); they include drowsiness, muscle tremors and respiratory depression,
General considerations and anaesthesia 17
Procaine
Procaine (novocaine) largely replaced cocaine, and has in turn been dis-
placed by lignocaine. However procaine may have economic advantages
over lignocaine. Proprietary brands include Planocaine®, Novutox® and
Willcain®.
Combined with adrenaline hydrochloride, procaine absorption is slow,
solutions may be sterilised by boiling and there is minimal tissue irritation.
Metabolite para-amino benzoic acid inhibits action of sulphonamides.
Bupivacaine
Bupivacaine, marketed as Marcain® (Astra) with and without adrenaline
(1:4 000 000) as a 0.25, 0.5 and 0.75% (plain) solution, has the following
properties:
18 Chapter 1
Cornual block
Anatomy
Sensitive horn corium is largely innervated by the cornual branch of the
zygomatico-temporal division of the maxillary nerve (from cranial V).
Caudally a few twigs of the first cervical nerve make a variable contribution to
innervation. The cornual nerve leaves the lacrimal nerve within the orbit,
passes through the temporal fossa and around the lateral edge of the frontal
bone, covered by fascia and thin frontalis muscle. The nerve is blocked a little
below the lateral ridge of the frontal crest, about halfway between the lateral
canthus of the eye and the horn (bud) base. The cornual artery and vein are
close to the site of block.
General considerations and anaesthesia 19
X
1
Figure 1.3 Site for cornual nerve block. A. rostral view; B. lateral view; 1 cornual
branch of zygomatico-temporal nerve. Note angle of insertion of needle, and also
line of cut in skin at horn base in dehorning (see Section 2.1, p. 57). X site on skull for
captive bolt euthanasia.
Equipment
Disposable syringe, 10 ml for adults, 5 ml for calves, 2.4 cm 20 gauge hypo-
dermic needle, 2% plain lignocaine or 5% procaine solution (2–8 ml depend-
ing on size).
Technique
• insert needle, with syringe attached, midway along lateral edge of crest of
frontal bone, directing needle at 30° angle through skin towards horn
base (see Figure 1.3)
20 Chapter 1
Complications
Failures are due to:
Infratrochlear block
Exotic breeds sometimes have an additional nerve supply from the
infratrochlear nerve to the medial aspect of the horns (similar to that seen
in goats). It is blocked by subcutaneous infiltration across the forehead,
transversely and level with the site of the cornual block.
Supra-orbital block
Indications
Surgery of upper eyelid, trephination of frontal sinus.
Technique
• palpate supra-orbital process to identify foramen midway between dorsal
and ventral borders, and dorsal to medial canthus, from which nerve
emerges (branch of cranial V)
• produce insensitive skin wheal over foramen
• insert 1.1 metric 2.5 cm long needle into foramen to depth of 1.5 cm and
inject 5 ml of 2% lignocaine (see Figure 1.4)
Alternative technique for regional anaesthesia is local infiltration.
A
E B
C
D
Figure 1.4 Supra-orbital nerve block. Oblique diagrammatic view of right side of
head. Foramen is palpable about 3 cm dorsal to upper bony margin of orbit. Long dotted
line is midline; dotted line is horn base. A. supra-orbital foramen; B. median line;
C. margin of bony orbit; D. orbit; E. frontal bone; F. right ear; G. horn base; H. poll.
Retrobulbar block
Indications
• intra-ocular neoplasia (e.g. SCC)
• severe trauma (see p. 68)
Technique
• produce topical analgesia of cornea with butyn sulphate or proparacaine
• insert forefinger into lateral canthus between eyeball and conjunctival sac
• alongside finger pass 1.25 metric 7.5–10 cm curved needle through
fornix of conjunctiva until point is retrobulbar (see Figure 1.5)
• ensure that needle point does not enter optic foramen (risk of intrathecal
{CSF} injection), and attempt aspiration check
22 Chapter 1
X X
Indications
Laparotomy, omentopexy, rumenotomy, caesarean section (flank incision);
ruptured bladder in calves (midline incision: bilateral paravertebral).
General considerations and anaesthesia 23
Equipment
Disposable 20 ml syringe, 3 × 1.25 metric 10 cm needles, such as Howard
Jones type without stilette, 2% lignocaine with adrenalin. Total volume of
solution is 60 ml (three sites) or 80 ml (four sites).
Fat beef cattle may require needle length up to 12–15 cm to reach correct
depth.
Technique
• block dorsal and ventral branches of spinal nerves emerging from thoracic
13, lumbar 1 and 2 (for most laparotomy procedures excepting caesarean
section) or L1, L2 and L3 (caesarean section alone)
• ensure good head restraint and, depending on temperament of cow, stand
on opposite side to that to be blocked, leaning over back
• clip and scrub skin from last rib to tuber coxae along a band 15 cm wide, to
left or right of dorsal midline as appropriate
• block L2 first: identify its transverse process by counting forwards from
last palpable process (L5) which is just cranial to sacral tuberosity of ilium
• locate point (adult Friesian cow) precisely 5 cm from midline and level
with caudal lateral edge of L2 transverse process (see Figure 1.6)
• punch needle vigorously through skin and longissimus dorsi musculature,
directed almost perpendicularly but with shaft inclined 10° medially
• advance needle firmly to contact and pass over caudal border of L2
transverse process, through intertransverse ligament (dense fibrous tissue
Field of analgesia
Commencing analgesia is noted by convex curvature of spine (scoliosis) on
injection side resulting from relaxation of longissimus dorsi and flank mus-
culature. Analgesia is complete within 10–15 minutes.
Field of analgesia runs slightly obliquely ventrally and caudally to midline.
Innervation of the individual dermatomes overlaps so that a block of single
nerve produces a very narrow (1–4 cm wide) analgesic skin band over the
flank. T13 innervates skin over middle of last 1–2 ribs (12–13), while L3
block causes analgesia as far caudal as os coxae. Dorsal ramus innervates skin
over upper one third of flank skin, the ventral ramus the remainder of the
flank (see Figure 1.7).
L1 L2 L3 L4
L3
T
13 L2
L1
Discussion
Block is easier in cattle in poor body condition. Analgesic technique in
exceptionally large-framed and fat cattle may require a needle 12 cm long.
Successful block results in moderate convexity of the spine on the analgesic
side (scoliosis), together with localised hyperthermia.
Block of L4 may sometimes cause mild ataxia. Advantages of paravertebral
block over flank infiltration include:
Equipment
Disposable 30 ml syringe, 0.9 metric 3.75 cm, 18 gauge hypodermic needles,
2% plain lignocaine; total volume about 60 ml.
Technique
• nerves to be blocked and field of analgesia see above
• insert needle 3 cm dorsal to the tip of transverse processes of L1, L2 and L4
for nerves thoracic 13, lumbar 1 and 2 respectively
• inject 10 ml in a fan-shaped area
• inject a further 10 ml of lignocaine ventral to the transverse process
Technique
• infiltrate subcutaneous tissues, muscularis and the sub-peritoneal layers
in three distinct movements
• insert needle at point where horizontal and vertical bars of imaginary ‘T’
join (see Figure 1.8). This point forms dorsal commissure of intended flank
incision
• pass needle (1.1 metric 10 cm) cranially to full extent subcutaneously,
and infiltrate with 2% lignocaine (plain) during slow withdrawal
• detach syringe and, without removing needle from skin, direct point
caudally and advance, and likewise infiltrate during withdrawal
• repeat with infiltration of deeper tissues (total of about 60 ml in horizontal
line)
• insert needle 10 cm ventral to previous point and similarly infiltrate pro-
posed incision line (another 60 ml, i.e. total about 120 ml in adult cow)
Note that needle is only inserted through skin twice in entire infiltration.
General considerations and anaesthesia 27
T13
Figure 1.8 Method of infiltration of body wall of flank in ‘T block’; technique can also
be used in ‘reverse 7 block’. Note that the needle is only inserted through skin twice in
whole analgesic procedure.
‘Reverse 7 block’
A slight variation in the linear infiltration of the flank is the ‘reverse 7 block’,
or ‘inverted L block’ which are self-explanatory (see Figure 1.8).
Epidural block
Indications
Caudal epidural: intravaginal and intrauterine manipulations (e.g. embry-
otomy), dystocia (block abolishes tenesmus), replacement of vaginal and
uterine prolapse, rectal prolapse, perineal and tail surgery.
Cranial epidural (same site, larger volume of analgesic solution): flank
laparotomy, surgery of hindlimbs and digits, penis, inguinal surgery, udder
and teat surgery.
Solution is injected into epidural space which caudally contains branches
of spinal nerves (cauda equina) invested with epineurium (dura mater), small
dorsal and ventral venous plexuses, and variable amount of fatty tissue.
Equipment
• 10 ml (caudal epidural) or 30 ml syringe (cranial)
• short bevelled 5 cm 1.25 metric needle
• 2% lignocaine without adrenaline
• 2% xylazine
Preparations containing preservatives such as chlorocresol and sodium
metabisulphite (e.g. Locovetic [Bimeda]) are unsuitable for epidural injection.
28 Chapter 1
Technique
• locate first intercoccygeal space (Co1–Co2) which undergoes signific-
ant movement when tail is elevated (sacrococcygeal space is virtually
immobile). It measures about 1.5 cm transversely and 2 cm craniocaud-
ally (see Figure 1.9)
• aseptic procedure, so clip site with scissors and disinfect. Entry of infection
is a serious problem, and can lead to permanent paralysis of tail resulting
in persistent faecal contamination of perineal skin and udder, and sub-
sequent culling
• insert needle precisely in midline, directed very slightly cranially, shaft
forming angle of 15–20° with vertical in standing animal. Note structures
penetrated are skin, fat and interarcuate supraspinous and interspinous
ligaments
• appreciate at depth of about 2 cm that point of needle is freely moveable
• inject 5 ml of lignocaine solution slowly
• an audible sound (‘whoosh’) may be appreciated
If resistance is encountered, the needle has been inserted too deeply and has
entered cartilagenous tissue of intervertebral disc (point cannot be moved
from side to side) or, though free in epidural space, needle lumen may be
blocked by fibrous tissue. In either case remove needle and repeat with new
needle.
Caudal (low) block – dose is 5–10 ml of lignocaine in adult cows, 10–15 ml
in bulls, 1–3 ml in calves (approx 1 ml/100 kg). Field of analgesia with caudal
block extends from tail base to ventral perineal skin and approximately
25–30 cm lateral to midline. Increased dosage to 30 ml invariably causes
ataxia, with recumbency in many individuals.
General considerations and anaesthesia 29
Discussion
Major disadvantage is the risk of injury during onset (ataxia) or recovery
phase (e.g. hip dislocation). Recovery to standing takes several hours, and
animal should not be permitted to attempt to stand until tail sensation
has returned. Keep in sternal recumbency with hind legs roped together
above hock, or sedate with xylazine or acetylpromazine to prevent attempts
to stand. Consider moving to straw-bedded box or yard.
Factors affecting extent of epidural block include volume, bodyweight,
pregnancy and position of cow.
Xylocaine-lignocaine combinations
Analgesia after epidural administration of xylazine (0.05– 0.1 mg/kg body-
weight of 2% solution, diluted to total volume of 5–10 ml with sterile 0.9%
NaCl solution or distilled aqua; alternatively 0.03 mg/kg diluted with 2% lig-
nocaine to 5 ml total volume for adult cow) lasts twice as long (four hours) as
after equivalent use of lignocaine HCI (0.2 mg/kg) alone. Very useful in cows
with chronic tenesmus (see Section 3.19, p. 138). Extent of perineal anaes-
thesia is more variable than with lignocaine, but has been reported to include
the entire perineal region, including udder and flank. Side-effects include
marked transient sedation, hindlimb ataxia, bradycardia and hypotension,
and can be reversed by i.v. tolazin (Priscoline HCI, 0.3 mg/kg) without affect-
ing analgesia.
Indications
Penile surgery distal to sigmoid flexure, examination of prolapsed penis in
standing animal.
Equipment
1.65 metric 12 cm needle, 30 ml syringe.
2% lignocaine
Technique
Larsen method involves block of the pudic nerve (fibres of ventral branches of
S3 and S4) and anastomotic branch of middle haemorrhoidal nerve (S3 and
S4) via an ischiorectal fossa approach.
30 Chapter 1
C C
S4 D
S3
B
A
Figure 1.10 Pudic (internal pudendal) nerve block. Diagram shows nerves (from
sacral 3 and 4), and injection sites A and B on medial surface of right pelvic wall and
floor of cow (pelvic viscera removed).
A. is just dorsal and lateral to sacro-sciatic foramen; B. is slightly more caudal and
dorsal; C. sacrum and coccygeal vertebrae 1–3; D. anus through which hand is
inserted only to wrist level; E. internal pudic artery (pulsation!) lies just ventral to sites
A and B.
• scrub perineal region clean and insert gloved hand in rectum to locate
nerve lying on sacrosciatic ligament immediately dorsal and lateral to
sacrosciatic foramen, which is less than a hand’s breadth cranial to anal
sphincter
• note pulsation of internal pudic artery just ventral to nerve
• insert needle forward at deepest point of ischiorectal fossa, directed slightly
downwards for a distance of 6 cm (see Figure 1.10)
• check position of needle point by rectal digital control and inject 20–25 ml
solution (2–3% lignocaine) around nerve
• inject a further 10–15 ml slightly more caudally and dorsally
• inject 10–15 ml slightly cranially and ventrally, at cranial border of fora-
men, for more effective block of ventral branch of the pudic nerve
• repeat procedure on other side of pelvis, reversing position of hands
Manipulation of a long needle is easier if a short stout (2.1 metric 2.4 cm)
needle is inserted through skin, producing analgesic skin wheal and serving
as canula for the longer needle. Alternatively caudal epidural block (5 ml)
rapidly desensitises the area of intended needle insertion.
Pudic block is effective after 30–40 minutes, and persists several hours.
The main advantage is that subject remains standing, while volume of
drug necessary to block nerve supply to penis by epidural technique almost
invariably causes posterior paralysis. Cleanliness and experience of the pelvic
General considerations and anaesthesia 31
landmarks are the main criteria for success with pudic block. Technical
failures are common in inexperienced hands, and delay before onset of anal-
gesia is a further drawback.
Technique
• infiltrate skin 2.5 cm from midline adjacent to the penile body
• insert needle, advancing to contact pelvic floor and withdraw 1 cm (see
Figure 1.11)
• check that needle is not intravascular (dorsal artery of penis)
• infiltrate 20–30 ml 2% lignocaine (plain) into region
• repeat procedure on opposite side of penis
Onset of analgesia in about 20 minutes, duration one to two hours.
B
A
E
Teat block
Indications
Teat analgesia is required for repair of teat lacerations (perforating fistula
and severe lacerations), polyps, sphincter damage causing obstruction, and
supernumerary teats. Analgesia is also needed for teat endoscopy (not dis-
cussed further).
Equipment
20 ml syringe, 1.10 metric 2.4 cm needle, catapult elastic and large curved
artery forceps.
2% lignocaine
Technique
• inject sedative drug into cow or heifer
• perform local infiltration of teat base after removing any obtruding hairs
from udder
• insert needle subcutaneously transverse to direction of teat, and make
subcutaneous injection of 10–20 ml solution as a peripheral (ring) block
(see Figure 1.12)
• accidental injection of anaesthetic into teat cistern or the circular veins at
teat base is not harmful but is ineffective in producing analgesia
• analgesia develops in 5–10 minutes
• place tourniquet or Doyen intestinal clamp (with rubbers) on teat base to
reduce bleeding and dripping of blood and milk
5
5
10
Figure 1.12 Teat ring block: 10–20 ml of 2% lignocaine are evenly distributed
around base of teat.
General considerations and anaesthesia 33
Discussion
Infusion of the teat cistern is not recommended. Even cases of polyps and
stenosed teat orifices prove difficult to block in this way because only the
mucous membrane becomes desensitised, presumably because subcutane-
ous and muscularis layers are also involved in the surgical trauma.
The entire teat is anaesthetised distal to the site of injection. An alternative
technique is by i.v. injection of any superficial teat vein distal to a tourniquet.
This produces analgesia throughout the teat. This technique is virtually only
possible in a recumbent cow.
Equipment
Tourniquet of stout rubber tubing, metal clamp to fix tourniquet, two rolls of
muslin bandages (or similar padding material), 20 ml syringe and 1.1 metric
4 cm needle.
Technique
Cow in lateral recumbency:
B
C
Figure 1.13 Intravenous regional anaesthesia. Lateral aspect of left hind limb of cow
showing two possible positions for tourniquet (A) and sites for injection into lateral
digital vein (B) and dorsal common digital vein (C, lying deep, at pastern between the
proximal phalanges).
• elevate limb using strap and buckle, fixed overhead (strap is efficient
tourniquet)
• note lateral saphenous vein prominent in proximal quarter of metatarsus
(see Figure 1.14)
• push vein sideways to make it more prominent and relatively immobile
• guide loaded syringe proximally towards vein using ball of thumb to
steady syringe (see Figure 1.15)
• analgesia develops in entire limb distal to tourniquet after about five
minutes and is optimal in ten minutes, persisting for at least 90 minutes
if the tourniquet is left in place
General considerations and anaesthesia 35
Figure 1.14 IVRA in standing cow in Wopa crush. Strap forms efficient tourniquet to
occlude lateral saphenous vein.
Discussion
The speed of onset is governed by the volume, since higher intraluminal
pressure causes more rapid diffusion of the solution (e.g. 30 ml versus 20 ml).
The tourniquet may safely be left for two hours, although few surgical proce-
dures ever require this length of time. Usually surgery is finished in 10–30
minutes, when the tourniquet may be safely released. Sensation returns
within five minutes. Lack of success is generally due to slackness of the
tourniquet which has failed to occlude the vascular drainage of some deeper
vessels. Analgesia occurs latest in the interdigital region.
Toxic signs have rarely been reported in cattle if the tourniquet has
remained in place for over 20 minutes. Signs of toxicity can include drowsi-
ness, minor convulsions and seizures, trembling and profuse salivation with
hypotension. Lignocaine is rapidly detoxicated in the liver.
36 Chapter 1
Figure 1.15 Close-up view of injection of anaesthetic solution into lateral saphenous
vein. Thumb pushes sideways to fix vein while simultaneously steadying syringe
barrel.
Indications
General anaesthesia (GA) is rarely indicated in cattle. It is practised if the
usual techniques of regional and local analgesia either cannot be adopted, or
fail. Specific indications include extensive surgery of the head, neck, chest
and abdomen, as well as the body wall and intra-abdominal experimental
manipulations, (e.g. embryo transfer), as well as most long bone fractures
when maximum relaxation is desired. GA has a relative surgical indication
General considerations and anaesthesia 37
Disadvantages of GA
Risks of GA in cattle include regurgitation, ruminal tympany, poor oxygena-
tion and skeletal injury.
(a) Risk of regurgitation and subsequent aspiration of ruminal contents
and saliva into the trachea, bronchi and alveoli with potential lethal
consequences (necrotic laryngotracheitis and necrotising broncho-
pneumonia with pulmonary oedema). Endotracheal intubation is there-
fore essential to avoid this problem.
Factors affecting regurgitation include:
• depth of anaesthesia (see Table 1.10) – light level provokes active regurgi-
tation, deep level passive regurgitation
• degree of ruminal distension or tympany
• fluidity of ruminal contents
• body and head/neck position
• body movement as in struggling and repositioning of animal
• volume of saliva
• duration of anaesthesia
(b) Risk of severe ruminal tympany (see above and below).
(c) Risk of severe compromise of the effective expansion capacity of
lungs as a result of:
• increased abdominal size following development of ruminal tympany
causing pressure on diaphragm
• relatively poor oxygenation of the dependent lower lung due to
inadequate circulation and pressure (ventilation-perfusion mis-
match). Poorly oxygenated blood from ventral lung mixes with better
oxygenated blood from upper dorsal lung, giving lowered systemic
oxygenation and increased CO2 retention (hypercapnia).
(d) Risk of skeletal injury in induction and recovery, involving possible
dislocation, myositis and nerve paralyses.
(e) Expense and size of gaseous anaesthetic equipment, and appropriate
expertise in its use.
Equipment
Apparatus for GA of cattle older than three to six months is similar to that
available for horses. Endotracheal intubation is essential in bovine GA.
Equipment for volatile and gaseous agents is of circle and to-and-fro pat-
tern, incorporating soda-lime canister and re-breathing bag with either an
38 Chapter 1
Cardiovascular system
Heart rate and rhythm tachycardia bradycardia, impending
arrest
Muscous membrane colour pink cyanotic
Capillary refill time < 2 sec > 3 sec
Respiratory system
Respiratory rate near normal shallow, irregular,
gasping, apnoea
Tidal volume slightly reduced more reduced
Character regular irregular
Ocular signs
Position and size of pupil moderately constricted, very dilated, centrally fixed
possibly rotated down
Palpebral reflex present very slow or absent
Corneal reflex present slow
Musculoskeletal system
Muscle tone
(lower jaw, limbs) moderate poor or absent
Other signs
Swallowing reflex absent absent
Salivary flow present, profuse absent
Lacrimal secretion present absent
Intravenous drugs
Intravenous agents for GA of cattle include:
Indications
Use with a dart gun (i.e. intramuscular injection) for restraint of dangerous
and uncontrollable cattle.
Dosage:
0.5–1 ml Immobilon™ per 50 kg bodyweight i.m. by dart syringe. Cattle
become recumbent some minutes later, and remain immobile for about
45 minutes. Generalised muscle tremors and poor muscle relaxation are usu-
ally apparent.
To reverse the drug an equal volume of Revivon™ (diprenorphine HC1)
should be injected i.v. Recovery generally occurs with minimal disturbance
and noise. A second half dose of Revivon™ may be given s.c. after the initial
i.v. dose if required.
Operator warning (from UK data sheet of LA Immobilon™/Revivon™)
To avoid accidental self-injection two sterile needles should be used, one to
fill the syringe, the second to inject the patient. After the calculated dose
has been withdrawn from the vial, the syringe should be removed from the
needle. The syringe should be connected to a second needle immediately
before delivery. Both needles should be discarded into a closed labelled con-
tainer. Operator should wear rubber gloves and should not pressurise vial
contents. Veterinarian should fully brief assistant on accident procedure
and administration of the reversing agent (LA Revivon™) should any
Immobilon™ be inadvertently absorbed through skin, mucous membranes
(mouth, eyes) or through injection.
Immobilon is highly toxic, causing dizziness, nausea, pinpoint pupils,
rapidly followed by respiratory depression, hypotension, cyanosis, loss of
consciousness and cardiac arrest.
The reader should consult specialised textbooks (see Further Reading sec-
tion, pp. 259– 60) for further details of bovine GA.
1.10 Shock
A state in which there is inadequate perfusion of tissues. Shock lesions result
from:
General considerations and anaesthesia 41
Baroreceptors in carotid
and aortic vasculature
Stimulation of
sympatheticosuprarenal system
Catecholamine release
Figure 1.16 Summary of some reactions following severe blood loss and shock.
42 Chapter 1
Introduction
Correction of fluid and electrolyte deficits may be critical in severe shock and
blood loss, in conditions such as right abomasal volvulus (see Section 3.7,
p. 110) and in severe, protracted toxic cases of bovine dystocia. A water
deficit can result from anorexia, dysphagia, diarrhoea and hyperosmolality.
Fluids
Dehydration is expressed as a percentage of total reduction of body fluids and
is estimated as follows:
Intravenous catheters are usually placed into the jugular vein following skin
preparation (Cathlon® IV, Johnson & Johnson, Intracath®, Becton Dickinson
16 G or 19 G for calves, 10 G or 12 G for rapid infusion in cows).
Technique
• i.v. dose of 7.2% sterile saline, 4 ml/kg over five minutes (i.e. 2–3 litres to a
600 kg cow) via 10G (Intracath®)
• avoid perivascular injection (tissue necrosis)
• ensure immediate access to unlimited fresh water (most cows will drink
20– 40 litres in the next 10 minutes)
• if patient does not drink within five minutes, give 20 litres of water by
stomach tube or i.v. isotonic saline
• i.v. HS may be repeated once after 24 hours
HS is useful as emergency treatment for severely diarrhoeic and (> 8%)
dehydrated calves, combined with oral electrolytes or followed by i.v. isotonic
saline (dosage as above).
General considerations and anaesthesia 43
Electrolytes
Introduction
Ideally, the solution is selected after determining the individual animal’s
needs by laboratory evaluation. However on the farm this is not practical. In
general cattle have rather consistent acid base and electrolyte abnormalities
associated with surgical disease. Dehydrated cattle are twice as likely to have
metabolic alkalosis as metabolic acidosis. Alkalosis is treated by giving a solu-
tion rich in chloride and potassium. Given adequate circulatory volume and
electrolytes, the kidneys can usually correct the alkalosis.
Oral rehydration can be achieved rapidly (e.g. 20 litres of dextrose and/or
saline in less than three minutes) using a stomach pump attached to an
oesophageal tube, which is protected from damage by the cow’s teeth by a
straight outer sleeve, one end of which has nose tongs attached for insertion
into the nostrils. Dehydration is easily corrected in adult cattle if combined
with i.v. therapy (see below) or sometimes alone to prevent, for example, bor-
derline ketosis.
Introduction
Anti-microbial drugs are no substitute for sound and aseptic surgical
technique in sterile aseptic procedures, neither can they be expected to
control deep-seated necrotic and purulent foci. These drugs should be con-
sidered as adjuncts to the natural defence mechanisms of the host. The
primary aim is to improve these mechanisms by proper preparation of the
surgical field, surgeon and the instruments, appropriate débridement,
excision of necrotic tissue, drainage and lavage, together with the prompt
re-establishment of the nutritional fluid, electrolyte and acid-base balance of
the patient.
One example is septic arthritis where joint lavage with saline is indi-
cated (see Section 7.27, p. 257) and may sometimes be replaced by more
radical open joint surgery, supported by systemic and local anti-microbial
chemotherapy. Antibiotic prophylaxis is not required during clean surgical
procedures in cattle (e.g. LDA abomasopexy, entropion surgery).
Prophylactic antibiotic therapy is however indicated in extensive
abdominal surgery, open fracture repair and non-sterile invasive procedures.
This therapy should start before the surgical intervention, the therapeutic
concentration should already be adequate at the start of surgery and the
intravenous route is preferable. The dose rates of prophylactic and therapeu-
tic antimicrobials are similar.
In contaminated sites, such as caesarean hysterotomy following prolonged
unsuccessful vaginal manipulation and a dead fetus, rectal tears requiring
extensive suturing, or in surgical sepsis, an adequate tissue concentration of
antibiotic should be rapidly established and therapy should continue for at
least three to five days after surgery. Initial anti-microbial drug selection is
usually arbitrary (broad spectrum) and may be altered following results of
sensitivity testing.
General considerations and anaesthesia 45
Table 1.12 Some guidelines for the antimicrobial sensitivity of certain drugs against
common bovine pathogens (see footnote).
Antimicrobial drug
Organism First choice Alternative choice (s)
Note: enormous variations exist between different laboratories and countries, also antibiotic
legislation is very variable, therefore obtain advice from nearest veterinary laboratory!
(c) = bactericidal; (s) = bacteriostatic; (s/c) = bactericidal in high concentrations only
† widespread resistance of Pasteurella spp. to tetracycline is recognised; alternative drugs are
sulfachlorpyridazine or erythromycin
‡ use in USA restricted to beef cattle
The most common bovine pathogens and their sensitivity are shown
in Table 1.12. The sensitivity may be variable depending on the area and
country.
Reasons for a failure of sensitivity testing are listed in Table 1.13. A failure
of response to anti-microbial therapy can be due to a variety of other reasons
(see Table 1.14).
The problem of milk withdrawal times in lactating dairy cattle must be kept
in mind (see Table 1.15). Currently ceftiofur HCL (e.g. Excenel RTU® sterile
suspension, [Pfizer] ) is a very popular systemic antimicrobial as it has a nil
milk withdrawal time.
46 Chapter 1
Impaired absorption
Accelerated elimination
Adverse drug interaction(s)
Inadequate penetration/drainage
Reduced phagocytosis
Drug antagonism
Superinfection
Impaired normal host defences
Underlying disease
Genotypic or phenotypic drug resistance
Tolerance
Ceftiofur Na (Naxcel®) 1 0 0 0 0
Ceftiofur HCl (Excenel®) 1 0 0 8 0
Trimethoprim/Sulphadiazine 1 6.5 2.5 34 5
Oxytetracycline 100 1 4 4 21 7–22
Oxytetracycline LA 4 7 4 14 28
Procaine penicillin G 1 2–5 2 3–4 10
Procaine penicillin G
+ streptomycin 1 2.5 2 23 30
Ampicillin 1 1–7 2 18–60 6
Erythromycin 1 2 3 7 14
Amoxicillin 1 1–7 NP 18–42 25
Framycetin 1 2.5 NA 49 28–38
Cefalexin sodium 1 0 4 19 4
Florfenicol (Nuflor®) 2 NP NP 30–44 28–38
Clav. acid/amoxicillin (Synulox®) 1 2.5 — 42 —
Enrofloxacin (Baytril®) 1 3.5 NP 14 28
• thorough débridement
• meticulous haemostasis
• elimination of dead space
• proper use of instruments
• judicious insertion of drains
• proper placement of sutures
Since the healing process is basically similar in all species (see Figure 1.17),
these points all apply to cattle. Bovine wounds fortunately heal without
production of exuberant granulation tissue which is commonly seen in
the horse.
Débridement is essential, especially when the wound (e.g. teat) is to be
sutured and in areas when gross contamination is commonplace.
48 Chapter 1
INJURY
coagulation
platelets
fibroblasts
INFLAMMATION
débridement contraction
resistance to
infection macrophages
granulocytes proteoglycan
synthesis
EPITHELIUM
new vascular
growth
collagen
lysis
collagen
synthesis
(remodelling)
HEALED WOUND
Dead space may be packed with sterile gauze swabs for 24– 48 hours to pre-
vent haematoma formation (see Section 2.7, pp. 69–70).
Drains are rarely indicated in cattle except for certain long bone fractures,
the thorax or subcutaneous or deep infected wounds (e.g. laparotomy inci-
sions) where:
Sutures in wounds:
Irrigation of wounds:
• large volume of clean non-sterile fluid (e.g. mains water) is more valuable
than small volume of sterile physiological saline
• ensure all pockets of deeper wounds are reached by irrigation fluids
• judicious use of 3% hydrogen peroxide, or 1% chlorhexidine solution
speeds removal of pus and tissue debris
• development of dead space may be prevented by judicious closed active
drainage (suction drainage, Redon type drain)
Skin sutures: single or interrupted mattress sutures of sheathed polyamide
polymer multifilamentous material (e.g. Vetafil®, Supramid® [Braun]),
monofilament nylon or polypropylene (see Table 1.5, p. 9)
Deep sutures in infected wounds: PGA, PDS
Drains:
• Penrose
• sialastic
• polypropylene, flexible and thin-walled with multiple openings in deeper
tissues
1.14 Cryotherapy
Introduction
Advantages of this technique include:
Equipment
Equipment may be small and readily portable (special vacuum flask), or
can be rather large and heavy, e.g. Frigitronics CE-8. Operator should wear
50 Chapter 1
disposable protective plastic gloves and avoid any possibility of cryogen con-
tacting the skin of involved personnel. General anaesthesia may be necess-
ary for delicate cryotherapy, since the affected area must be kept immobile
during treatment.
Technique
• wash and dry area and apply a little paraffin jelly or vaseline (e.g. KY®
jelly) for improved initial adhesion
• if spray is to be used, mask off surrounding area with piece of plastic sheet
or with thick layer of vaseline
• select suitable probe head (e.g. flat, 10 mm or 20 mm diameter) or spray
attachment (2.36–1.25 metric needle, depending on desirability of coarse
or fine spray)
• if necessary attach flexible extension piece to keep apparatus vertical and a
short distance from operating site
• if available, and working near vital structures, insert thermocouples: drop
of reading to −20°C is critical and indicates need to arrest cryotherapy at
once
• in absence of thermocouples and in most situations in cattle, digital assess-
ment of size and position of iceball is quite reliable
• produce rapid freeze and permit slow thaw cycle; two cycles necessary for
N, three for N2O or CO2
• assess extent of iceball by digital palpation. Probe is removed after natural
thaw, or after activating automatic defrosting device
• do not repeat freeze until area is completely thawed. Effectiveness of proce-
dure depends on sequence of rapid freeze-slow thaw cycles
• warn owner or stockperson to anticipate tissue necrosis and slough in
seven–ten days, leaving a healthy granulating surface, which should be
kept clean as epithelialisation proceeds from periphery inwards
Discussion
Factors affecting degree of cryonecrosis include:
Indications
Collection of venous samples (volume up to 10 ml) with minimal restraint
and little or no assistance. Obvious advantages over collection from jugular
or subcutaneous abdominal (milk) vein (latter not recommended). Minimal
risk of infection and sporadic haematoma formation insignificant, so tail
paralysis is virtually unknown.
Technique
Collect into evacuated blood collection tubes containing edetic acid
(EDTA), heparin etc., or without coagulant (Vacutainer® [Becton Dickinson,
Rutherford, NJ]) via 0.9 metric 4 cm needle which is screwed into plastic
holder into which collection tube is inserted. Alternatively collect via 0.8
metric 2 cm needle into polypropylene syringe (5–10 ml) with negative
pressure.
Figure 1.18 Method of restraint for obtaining blood samples from coccygeal vein.
52 Chapter 1
• cleanse tail site of gross faecal contamination with paper towel or cotton
wool
• with free hand locate palpable vein in midline, just caudal to insertion of
skin folds of tail at level of coccygeal (Co) vertebrae 6–7
• insert needle just cranial to bony protuberance of haemal process in mid-
line to depth of about 8–12 mm (in Vacutainer® system, insert needle into
tube), and withdraw slightly until bloodflow starts
• if initially unsuccessful, reduce tension of tail slightly and continue at
same site, otherwise attempt at Co 5–6
• do not massage puncture site after venepuncture
Other reports claim that sites of Co 3–5 are preferable, but anatomical studies
show the vein lies to the right of midline in the ventral sulcus of the vertebral
body at the more cranial site.
Insignificant haematoma develops in a small number of cases, but dis-
appears in a few days. Procedure does not cause thrombophlebitis or total
occlusion of vein, and repeat samples are easily obtained some days or weeks
later.
Introduction
Until the 1960s congenital defects in cattle were thought to be largely herit-
able. There has been a slight but perceptible change in this attitude of veter-
inarians, cattle breeders and geneticists. ‘Congenital’ is not synonymous
with ‘heritable’ or ‘genetic’. There remains a great paucity of information. A
limited number of conditions can be corrected surgically, and where it is
likely that the condition is inherited, steps should be taken (e.g. castration,
sterilisation, or crushing of teats) to avoid breeding from such stock.
Incidence of congenital defects in cattle is 0.2–3%, with 40–50% born
dead. Most defects are visible externally. Congenital defects reduce the value
of affected calves, and frequently of their normal relatives too. Economic
losses are particularly severe when congenital losses are combined in a
syndrome involving embryonic and fetal mortality. Such losses are often
increased by longer calving intervals resulting from dystocia and subsequent
infertility. Breeding programme changes subsequent to such incidents may
require the introduction of less popular and profitable stock.
Close collaboration between veterinarians, farmer and geneticist is essen-
tial. Good breeding records are a vital tool.
Examples
Examples of the more common defects of each body system are:
CHAPTER 2
Indications
• improve stock management
• prevent potential aggressive behaviour towards other members of herd
and stock personnel
• reduce traumatic damage to such persons and other individuals and stock,
especially udder and skin injury resulting in eventual lowered hide value
Selection of technique
In the UK all calves over one week old may only be disbudded or dehorned
under anaesthesia or analgesia (Animal Anaesthetics Act 1964). In some
other countries (e.g. Switzerland), regardless of age, anaesthesia is manda-
tory. Under proposed animal welfare guidelines, it is suggested that dehorn-
ing (not disbudding) may ultimately be outlawed. The veterinarian should
strive, under Herd Health Plans, to convince farmers to disbud at an early
age.
Very young calves (< 1 week old) may be disbudded by application of a local
caustic compound (NaOH, KOH, collodion). Wear protective gloves. Clip hair
from horn buttons. Protect surrounding skin with petrolatum, and apply thin
film of paste. Confine calves for 30 minutes. Use of caustic preparations may
be forbidden in some countries (e.g. Switzerland).
The ideal age for disbudding is one to two weeks old, when horn buds
project 5–10 mm, are easily palpable, and a disbudding iron can be used
alone (see Figure 2.1a,c). Haemorrhage is nil.
From about one to four months (horn length 3–5 cm) a Barnes dehorning
gouge (see Figure 2.1b,d), Roberts dehorning trephine, or double action
hoofshears may be applied, followed by a disbudding iron for haemostasis.
Alternatively the Danish debudding gouge is available. The bud and peripheral
Head and neck surgery 55
A
C
B D
Technique of disbudding
• restrain calf with hindquarters in corner and head held by thumb and
fingers placed between and below jaws, assistant leaning against shoulder
region
• place hot (electrical or gas-powered) disbudding iron on bud and rotate
several times, angling the instrument so that the edge burns the skin
around the periphery of the bud to include adequate germinal epithelium
(see Figure 2.1c)
56 Chapter 2
• pressing and moving head laterally, scoop and flick off the horn bud,
leaving a crater, in the middle of which is a small cartilaginous protusion,
which may be left since it is not germinal epithelium
• operate on older calves by placing blades of Barnes dehorner precisely
around base of horn bud and removing small (3–5 mm) strip of skin at same
time as bud is guillotined off. Effect haemostasis with hot disbudding iron
• alternatively remove horns as short as 5 cm rapidly with embryotomy
wire (more physical effort but minimal haemorrhage due to heat)
Comparison of instrumentation
In yearling and adult cattle the preferred method is embryotomy (obstetrical,
Gigli) wire, disadvantages being the considerable physical effort and
relatively slow speed. Advantages include neat appearance and lack of
haemorrhage.
Saw method is more unsightly and control of haemorrhage takes longer.
Dehorning shears (e.g. Keystone dehorner) is the most rapid method but
causes considerable haemorrhage and has a major disadvantage in that, if
analgesia is absent or poor, sudden violent movement of the head (avoided by
firmly anchored halter!) during closure of the guillotine blades can cause a
shear fracture of the frontal bone and secondary wound problems including
frontal sinusitis. In addition the shears method raises questions of acceptable
animal welfare if analgesia is not confirmed before its application.
Dehorning of cattle without demonstrable analgesia is an unethical and
unprofessional act.
Technique of dehorning
• sedation occasionally indicated
• cornual nerve block (see Section 1.8, p. 19). In adult cattle infiltrate
further anaesthetic solution at caudal border of horn base
• wait five to ten minutes
• check with needle that skin adjacent to horn is painless
• obtain adequate restraint of head in gate of crush and position head
straight forward so that considerable weight can be exerted on embryotomy
wire during sawing movement (see Figure 2.2). Likewise, when using
saw, ensure that operator’s position is optimal
• first cut is made with wire or saw on lateral aspect
• place wire and saw so that instrument passes through skin about 1 cm
from skin-horn junction
• ensure that direction is correct, especially with saw, since change of
direction brings greater difficulties in moving blades
• ensure that blade or wire emerges dorsally through skin lateral to midline
of poll. In Friesian/Holstein cows width of skin left in midline should be
5– 8 cm
• avoid interrupting sawing movement in middle of dehorning process
Head and neck surgery 57
Blade of
dehorner must
Centreline of be below, or at,
shears should base of horn
be 30–45° from
line of head
Crush gate
Figure 2.2 Position of cow’s head and of dehorning shears (Keystone) or saw.
Note that (a) haltered head is pulled forwards away from crush gate, and to side;
(b) cutting angle should be 30–45°; (c) blade or wire is placed onto skin of
horn-skin junction.
Relatively narrow diameter horns (< 5 cm) may be removed using long-
handled dehorning gouge (Barnes pattern). This instrument may also be
useful in removing additional protruding lips of horn where the initial
procedure has been too conservative.
Haemostasis
• torsion or torsion/traction on the 2–3 major vessels in the medial aspect
(ventral crescent) of the peripheral skin; they are easily identified and
picked up by artery haemostatic forceps, six to eight turns are optimal
• rubber tourniquet or string around the two horn bases (such as rubber
bands made from cross-sections of car inner tubes or baling twine) applied
in pattern to exert pressure on dorsal horn border as well
• alternatively push wooden toothpick into bone canal from which con-
siderable blood can spurt (remove toothpick the next day)
• cautery, e.g. hot iron, electrocautery, is often disappointingly ineffective
• liberal use of bacteriostatic (e.g. non-sterile furazolidone or sulphanilamide)
or haemostatic powder (Fe salts, tannic acid, alum)
58 Chapter 2
• ensure dehorned cattle are checked regularly for 24 hours after surgery
for any recurrence of bleeding which may result from local irritation and
pain leading to rubbing the cut surface against a wall
• clip band 8 cm wide over poll and around base of each horn
• routine skin preparation
• cornual nerve block and local analgesic infiltration caudal to horn base
and in midline
• make transverse incision over poll and laterally in curved fashion passing
0.5 cm from horn-skin junction, the two wounds joining lateral to horn
base and continued towards mandibular joint for 5 cm (see Figure 2.3)
• undermine skin peripherally from incision far enough to avoid skin
damage when horn is removed by saw or Barnes dehorning gouge
• remove more horn if necessary (sterile bone chisel and hammer, Barnes
gouge) until cut is exactly flush with frontal bone
• clean surface with sterile swabs and effect haemostasis
• undermine skin further to enable edges to be apposed across bone surface
without excessive tension, then check cosmetic appearance
• appose edges with interrupted sutures of monofilamentous polypropylene
• clean surface of all blood and debris, and apply antibiotic powder
• remove sutures in 14 days
1
2
3
Figure 2.3 Incision and nerve supply for cosmetic dehorning. (A) Rostral view;
(B) lateral view.
1. zygomatico-temporal nerve; 2. frontal nerve; 3. infratrochlear nerve; --- skin
incision.
walls). Most infected wounds can be cleaned easily, but infection extending
into the frontal sinus can cause chronic discharge of pus (often A. pyogenes) to
pass into the maxillary region, sometimes with systemic illness (e.g. pyrexia,
anorexia, loss of condition, head tilt, localised swelling and pain). Drainage
by sinus trephination may then be indicated (see Section 2.2 below).
60 Chapter 2
11 5
12 4
10 8
13 6
9
14
15 7
16 X
17
Figure 2.4 Median section through head, left half. (From Pavaux, 1983.)
1. caudal frontal sinus; 2. medial rostral frontal sinus; 3. sphenoidal sinus; 4. nasal
cavity; 5. nasal septum; 6. hard palate; 7. root of tongue; 8. soft palate; 9. isthmus
faucium (oral part of pharynx, oropharynx); 10. nasal part of pharynx (nasopharynx);
11. pharyngeal septum; 12. nasopharyngeal meatus; 13. laryngeal part of pharynx
(laryngopharynx); 14. entrance to larynx (laryngeal aditus); 15. vestibule of
oesophagus; 16. oesophagus (cervical part); 17. cavity of larynx.
X shows common site of oesophageal obstruction; long arrow shows hand passed
into pharynx, and short arrow the retrograde pressure on oesophagus. (From Pavaux;
1983.)
Indication
Frontal sinusitis with considerable volume of pus occupying the multi-
loculated structure and with chronic discharge through the horn base.
X 4
4
3
2
Figure 2.5 Diagram of longitudinal and rostral sections through skull to show extent
of sinuses.
1. frontal sinus; 2. maxillary sinus; 3. position of orbit; 4. rostral compartments of
frontal sinus; X trephine sites for empyema of frontal sinus. (Modified from Dyce &
Wensing, 1971.)
the cornual diverticulum and nuchal diverticulum which ends by also exca-
vating the parietal, occipital and temporal bones. Two or three small cham-
bers lie level with the rostral part of the orbit.
The borders of the frontal sinus are from the rostral part of the orbit to a
transverse line drawn through the midline of the orbit, laterally to the frontal
crest, and caudally to the nuchal crest (poll). A midline septum separates
the two frontal sinuses. The normal small communication of the frontal
sinus with the ethmoid sinus and the nasal cavity is usually occluded due to
thickening of the mucosa and purulent discharge.
For clinical signs of frontal sinus empyema see section on complications
of dehorning (see Section 2.1, p. 58). Some cases result from horn fracture,
usually a direct result of uncontrolled movement of the head (poor anaes-
thesia). Sinusitis is often confined initially to caudal part of sinus.
62 Chapter 2
Technique
• restrain animal adequately in crush/chute and give sedative
• clip hair around horn base and over whole of frontal region, cleanse and
disinfect
• produce local analgesia by supra-orbital block (see Section 1.8, p. 20) or
infiltration over site of proposed trephine opening. The trephine opening
may be located 5 cm dorsal to the line joining the two supra-orbital pro-
cesses and about 5 cm from midline. Further landmark: 2–3 cm abaxial at
the level of a horizontal line joining the axial parts of both orbits. Some-
times a soft area of bone presents a suitable site. A ventral site is preferable
if the horn sinus is still patent, permitting flushing from one opening to the
other. Avoid the supra-orbital foramen and vein (see Figure 1.4)
• remove circular area of skin, subcutaneous tissue and cutaneous muscle
3 cm diameter by scalpel and forceps
• elevate periosteum with periosteal elevator and remove it with scalpel
• trephine bone over sinus using 2.5 cm diameter Galt or Horsley pattern
trephine
• flush sinus cavity initially with warm water using enema pump, then with
hydrogen peroxide (3%, i.e. 10 vol, diluted with equal volume of water)
• insert enema pump (Higginson’s syringe) to direct the irrigating mixture
into the various compartments
• continue irrigation through horn sinus orifice
• irrigate finally with dilute chlorhexidine hydrochloride solution (10 ml of
5% solution made up to 1 litre with water), flushing from top to bottom
• pick up any major bleeding points with artery forceps and maintain
trephine opening patent for daily flushing by stock person
• avoid feeding hay/straw from overhead rack
Discussion
In consideration of the possible and safe sites for trephination, note that
the site for euthanasia using a captive bolt gun is midline at the junction of
diagonal lines joining the medial canthus of the orbit to the ventral border of
the opposite horn base (see Figure 2.3a).
Head and neck surgery 63
2.3 Entropion
Indication
• correction of congenital or acquired inversion of upper or lower lid
Left eye
dorsal
medial lateral
ventral
Figure 2.6 Entropion correction involving lower lid of left eye with skin incision 2 mm
below lid margin.
64 Chapter 2
B
A
Figure 2.7 Third eyelid flap in right eye. Shaded area is third eyelid A. sutured into
dorsolateral fornix; B. by suture through skin; C. supported by 1.5 cm long plastic stent
D. Note that suture does not penetrate full depth of third eyelid, therefore does not
contact corneal surface.
Indications
Cases of extensive corneal ulceration and of traumatic damage, often in
which antibiotic medication has failed to achieve early resolution of the
lesion.
• insert 1 cm polypropylene stent onto suture over skin, and tie in ‘quick
release’ fashion with sufficient tension for third eyelid to cover entire
visible surface of cornea, including the lesion
• inspect eyelid suture daily (stockperson), apply any local medication and
perhaps slacken off suture to inspect cornea for assessment of healing
process
• leave suture in place for two to three weeks, then remove with scissors
Discussion
No comparative studies are available on the success of this simple and
common technique. Results are generally good as bovine cornea has great
powers of healing.
Introduction
Neoplasms of the upper and lower lids and nictitating membrane (third
eyelid) include squamous cell carcinoma (SCC) or ‘cancer eye’, and rarely
other tumours such as papillomata, and fibrosarcoma. SCC is most signific-
ant in terms not only of incidence but also of economic importance and
prognosis. SCC occurs more frequently on the globe (65%) than upper and
lower lids (30%) or third eyelid (5%), is very invasive locally, and may meta-
stasise to the local lymph nodes (parotid, atlantal or retropharyngeal and
the anterior cervical chain).
Clinical signs
SCC is largely confined to Hereford and Simmental breeds and their crosses,
where the non-pigmented area is liable to develop neoplastic lesions under
the influence of ultraviolet radiation from sunlight. Affected cattle are usually
four to nine years old. About 85% of cattle with SCC lack pigment in the
affected area.
The lesion is often an obvious proliferative irregular mass which may
ulcerate through the skin to cause moderate distress and blepharospasm.
66 Chapter 2
Treatment
Treatment is indicated in early lesions without evidence of secondary spread
to adjacent structures (e.g. bone) or metastases to the drainage lymph nodes.
Several techniques are available and include:
(a) excisional surgery
(b) cryotherapy
(c) hyperthermia
(d) radiotherapy (rare)
(e) immunotherapy (rare)
(f) combinations of a+b, a+d or c+e
Cryotherapy
Cryotherapy (see Section 1.14, p. 49) is particularly advantageous since
the technique avoids haemorrhage and is simple and relatively fast. The
small liquid nitrogen flask (Nitrospray® [Arnolds] ) is adequate for lesions up
to 5 cm diameter and 1 cm deep.
Other techniques
• excisional surgery: often indicated in large lesions to reduce size (‘debulk’)
prior to cryotherapy
• radiofrequency hyperthermia: application of heat (50°C for 30 seconds)
to various surface points of tumour and surrounding skin using probe
head. Penetration is limited to 0.5–1 cm, therefore inappropriate for large
masses
• radiotherapy: radon and gold seed implants have both been successfully
used in valuable cattle. Penetration is again only 0.5–1 cm
• immunotherapy: local infiltration of mycobacterial cell wall fraction
immunostimulant (Regressin® [Ragland], USDA-approved drug for immuno-
therapy). Dose rate is 0.5 ml for each centimetre of tumour diameter, i.e.
5 cm diameter mass is given 2.5 ml. It is claimed that untreated sites often
undergo spontaneous regression
• Prognosis: recurrence possible
Introduction
Foreign bodies such as particles of chaff, burrs and thorns may lodge on
the corneal surface, particularly in lateral or medial canthus, and provoke
a reactive keratoconjunctivitis. Signs are obvious in recent cases with
epiphora, ptosis, blepharospasm and discomfort. Chronic cases show corneal
scarring and pigmented keratitis. Such material may often be removed with-
out local analgesia. Suitable topical analgesics include amethocaine (e.g.
Minims® Amethocaine HCL, [Smith & Nephew Pharmaceuticals] ), xylocaine
(4% eyedrops – Astra®), or Proparacaine (Ophthaine®, Ophthetic®).
68 Chapter 2
Technique
• hold head firmly and tilted in good light so that material is, as far as
practical, in midfield of orbital fissure
• spray sterile saline through 22 gauge needle hub tangentially at foreign
body to dislodge it
• if unsuccessful then attempt dislodgement and removal with fine dis-
secting forceps or with fine flat surface such as blunt surface of large
scalpel blade
• assess superficial corneal damage subsequent to removal, following
instillation of one to two drops of fluorescein stain (Minims® Fluorescein
sodium 1% or 2% [Smith & Nephew Pharmaceuticals] )
• insert local broad spectrum antibiotic (e.g. cloxacillin, Orbenin®, [Beecham] )
four times daily for three days after removal. Ointments are more suit-
able than drops. Topical 1% atropine b.i.d. or to effect to maintain pupil
dilatation. Corticosteroids may be contra-indicated as they hamper repair
of any residual ulcer.
Indications
• intra-ocular neoplasia and gross damage to bulb, usually with severe
primary or secondary infection, e.g. infectious bovine keratoconjunctiv-
itis (Moraxella bovis ± Neisseria spp.) associated with trauma or rupture
of globe, resulting in anterior staphyloma or panophthalmitis, and risk of
ascending infection up the optic stalk.
Enucleation is rarely indicated in cattle. Cosmetically satisfactory appear-
ance is not so important as in equines and small animals.
Figure 2.8 Exenteration of eye (longitudinal diagrammatic section). Dotted line (A)
starts in the lids, passes through the peri-orbital structures and results in removal of
globe, all orbital contents, eyelid margin and conjunctiva. B. optic nerve and vessels;
C. muscles. Shaded areas above and below are frontal and zygomatic bones.
• grasp eyeball and use further traction to dissect it free from surrounding
retrobulbar tissue (excluding conjunctival sac) and optic nerve
• leave the maximal amount of healthy retrobulbar tissue
• clamp ophthalmic vessels, optic nerve and retractor bulbi muscle with
slightly curved, long-handled artery forceps (Roberts 23 cm, or Kelly
25 cm)
• ligate vessels with 7 metric chromic catgut
• remove third eyelid and Harderian gland
• check site for complete removal of all neoplastic or infected tissue
• meticulous haemostasis during enucleation is time-consuming and in
most cases not necessary
• pack the orbital space for a few minutes with sterile gauze while subcut-
aneous layer of simple interrupted sutures of chromic catgut is inserted,
or insert absorbable gelatinespmges
70 Chapter 2
Complications
Complications include failure or inability to remove all neoplastic tissue (SCC),
massive intra-orbital haemorrhage, abscess formation, excessive dead space,
and failure to appose the skin margin without excessive tension on sutures
(relieving sutures may help).
2.8 Tracheostomy
Introduction
Necrotic and purulent laryngitis (caused by Fusobacterium necrophorum infec-
tion and Arcanobacterium pyogenes abscessation respectively) secondary to
intra- or retro-laryngeal foreign bodies, or other mechanical irritants (dust,
repeated coughing due to Haemophilus somnus and other pathogens).
Indications for tracheostomy rarely involve pharyngolaryngeal neoplasia,
retropharyngeal abscessation, foreign bodies in upper respiratory tract, or
persistent laryngospasm. Surgical conditions of head involving haemorrhage
and potential aspiration of blood and infected tissue should be managed with
an endotracheal tube in position. Tube should only be removed after return of
cough and swallow reflexes.
Clinical signs
Signs indicative of need for tracheostomy, which is often an emergency pro-
cedure, include progressive dyspnoea, stridor, and mild cyanosis. Some
animals have fetid breath (F. necrophorum), and pharyngeal lesions which
can be both seen and palpated. In all cases a mouth gag should be inserted
and a long-bladed laryngoscope or endoscope used to aid examination of the
affected area.
Anatomy
Tracheal rings are readily appreciated on deep palpation of upper part of
neck. Diameter is narrow compared with equine trachea. Depth is slightly
Head and neck surgery 71
15 6
11
5 3
15
7 1 2 8
4
10 9
12
14
14
13
Figure 2.9 Cross-section of neck at level of fifth cervical vertebra, ventral part,
looking caudally.
1. trachea; 2. oesophagus; 3. right common carotid artery; 4. right external jugular
vein; 5. right internal jugular vein; 6. right vagosympathetic trunk; 7. right recurrent
laryngeal nerve; 8. left common carotid artery; 9. left external jugular vein; 10. left
internal jugular vein; 11. left vagosympathetic trunk; 12. left recurrent laryngeal
nerve; 13. sternohyoid and sternothyroid muscles; 14. sternocephalic muscle;
15. brachiocephalic muscle. (From Pavaux, 1983.)
greater than width. Trachea is related at junction of upper and middle thirds
of neck to oesophagus on left side, and to carotid sheath, enclosing common
carotid artery, vagosympathetic trunk and internal jugular vein on the right
and to a lesser extent on the left. The trachea is approached through the two
bellies of the bulky sternomandibular muscles and the finer sternothyrohyoid
muscles, which are fine muscular bands on the ventral tracheal surface
(see Figure 2.9 which is a cross-section somewhat distal to preferred tra-
cheostomy site).
Technique
• perform surgery on standing, haltered animal (in crush/chute) under
local infiltration of analgesic solution (2% lignocaine with adrenaline)
• premedicate difficult animals with xylazine, but avoid premedication in
animals with signs of severe cardiovascular and respiratory dysfunction
• maintain head and neck in extension
• identify midline in upper half of neck at level of tracheal rings 4– 6
• clip and disinfect skin over this area and make longitudinal incision 6 cm
long through skin and subcutis directly over the tensed trachea
• separate the paired sternomandibular muscles in midline by blunt dis-
section, followed by sternothyrohyoid muscles
72 Chapter 2
Ligament
Introduction
Oesophageal obstruction is usually due to round or irregular pieces of food
material, e.g. potato, turnip or sugar beet, rarely to sugar beet pulp (cf. horse).
It can usually be relieved by medical means (e.g. tranquillizers such as
phenothiazine derivatives, relaxants) and manual retrograde manipulation.
Site of obstruction is usually the proximal cervical oesophagus, often in the
first 20 cm (see Figure 2.4, (x) ) and rarely the distal cervical or thoracic
oesophagus.
Distal thoracic oesophageal obstruction is sometimes seen in calves due to
‘broken’ stomach feeders following oral rehydration therapy. Rarely oesophageal
obstruction results from external compression (thymic lymphosarcoma,
mediastinal lymphadenopathy) and neurogenic dysfunction (rabies).
Oesophageal obstruction is rarely life-threatening as long as care is taken
to control development of rumenal tympany. Insert temporary rumenal
canula. Oesophagotomy should be a last resort procedure.
Oesophagotomy is only practical in proximal two-thirds of the cervical
part, where organ is relatively accessible, lying in deep fascia to left of the
trachea and overlaid by the left jugular vein and the carotid sheath enclosing
the carotid and vagosympathetic trunk.
Prognosis
It is difficult to ensure the primary healing of oesophageal incision, but
chances are increased by keeping animal on fluids for two days, followed by
three days of mash and short-cut fodder.
Bovine Surgery and Lameness, Second Edition
A. David Weaver, Guy St. Jean, Adrian Steiner
Copyright © 2005 David Weaver, Adrian Steiner and Guy St Jean
CHAPTER 3
Abdominal surgery
3.1 Topography
Topography of the forestomachs and abomasum (see Figure 3.1) is incor-
porated in descriptions of approach (e.g. left flank laparotomy, traumatic
reticulitis). The complex topography of the intestinal tract is considered in
this introduction.
9
8
7 6
1
10
2
13
11 15
15 13
4 11
14 14
3 12
20
12
17
16
Figure 3.1 Horizontal section of trunk at mid-height of thorax and thighs, looking
ventrally.
1–5. rumen: 1. atrium (cranial sac); 2. dorsal sac; 3. caudodorsal blind sac; 4. ventral
sac; 5. caudoventral blind sac; 6. reticulum; 7. spleen; 8. liver; 9. caudal vena cava;
10. omasum; 11. jejunum; 12. caecum; 13–15. ascending colon: 13. proximal loop;
14. spiral loop; 15. distal loop; 16. urinary bladder; 17. uterine horns. (From Pavaux,
1983.)
initially freely mobile, but with the next portion firmly adherent to the vis-
ceral hepatic surface. It curves in an S-shaped manner near the bile and pan-
creatic duct openings, and becomes the descending loop, which is suspended
dorsally by the mesoduodenum, and the loop passes caudally in the dorsal
and right lateral part of the abdominal cavity (see Figure 3.2). Superficial and
deep parts of the greater omentum attach to the ventral surface of the
descending loop of the duodenum.
Abdominal surgery 77
4
8
1 1
6
7 9
short caecocolic fold attaches the caecum to the colon dorsally. The caecum
often extends caudal to the limits of the supraomental bursa.
The proximal loop of ascending colon passes cranial to the level of T12 then
turns caudally to pass dorsally to the first segment. It again turns craniad, but
now to the left of the mesentery, and then ventrally to become the spiral loop
of the ascending colon. The arrangement comprises two centripetal, followed
by two centrifugal coils (see Figure 3.3). The central flexure is the mid-point
and the change in direction of the spiral colon. The distal portion of the spiral
colon is normally adjacent to the ileum. The distal loop of the ascending colon
passes caudad along the left side of the mesentery, around which it turns
to run craniad again, adjacent to the proximal colon. It then becomes the
transverse colon, which passes from the right to the left side, around the
cranial edge of the cranial mesenteric artery.
The descending colon proceeds caudad along the dorsal surface of the
abdomen, attached by the mesocolon. The mesocolon is rather elongated
at the level of the duodenocolic ligament, affording it some mobility. The
descending colon terminates in the rectum, which lies entirely intrapelvic.
The relative shortness of the mesentery means that exteriorisation of
intestine is difficult in many areas. Vessels and lymph nodes within the
mesentery are hard to identify due to the fat deposition. The ascending
10
11
3
9
7
6
5
8 7 4
8
1
7
Figure 3.3 Diagrammatic representation of small and large intestine, viewed from
right side.
1. pylorus; 2. descending limb of duodenum; 3. ascending limb of duodenum;
4. proximal jejunum; 5. distal jejunum and ileum; 6. caecum; 7. proximal loop and
centripetal gyri of colon; 8. centrifugal gyri of colon; 9. ascending terminal colon;
10. descending colon; 11. rectum. Length (in adult) of small intestine is 40 m, that of
the large intestine is 10 m.
Abdominal surgery 79
duodenum, proximal and distal loops of ascending colon, and the cranial
portion of the descending colon lie close to one another due to the near-fusion
of their mesenteries. The cranial mesenteric vessels supply the small and
large intestine, except for parts of the duodenum and colon.
The greater omentum passes from its origin on the duodenum, pylorus and
greater curvature of the abomasum, encircles the intestinal mass, and inserts
on the left longitudinal groove of the rumen (superficial part), while the deep
part passes similarly ventral and to the left, to attach to the right longitudinal
groove of the rumen. These two parts are fused caudally forming the caudal
fold. The lesser omentum extends from the oesophagus along the reticular
groove and omasal base to attach to the lesser curvature of the abomasum,
and covers most of the parietal surface of the omasum.
Indications
Specific indications are suspected left displaced abomasum (LDA) (see Sec-
tion 3.6), rumenotomy, traumatic reticulitis (see Section 3.4), or caesarean
80 Chapter 3
3
1
6 7
12
8
13
10
13
11
section (see Section 4.1). LDA is evident on opening into peritoneal cavity.
Traumatic reticulitis may be suspected on exploration of area between
cranial aspect of ruminoreticulum and the diaphragm-body wall area. In
positive cases specific surgical correction is performed.
Indication is often not clearcut. Some cattle show persistent abdominal
pain apparently localised to ruminal area. Left flank exploratory laparotomy
Abdominal surgery 81
1 8
7
6
10
9
2
12
11
13
5
4
Figure 3.5 Cross-section of trunk through body of ninth thoracic vertebra, looking
cranially.
1. body of ninth thoracic vertebra and head of ninth rib; 2. eighth rib; 3. seventh rib;
4. xiphoid process of sternum; 5. sternal part; 6. thoracic aorta (thoracic duct, to right,
and left azygos vein to left, coursing along it dorsolaterally); 7. left lung (caudal lobe);
8. right lung (caudal lobe); 9. liver; 10. caudal vena cava; 11. omasum; 12. atrium
(cranial sac) of rumen; 13. reticulum. (From Pavaux, 1983.)
L6
L5
L3 L4
T13 L1 L2
1 2
5 4
3
Figure 3.6 Position of various left flank incisions (see also Figure 1.7, p. 25).
1. paracostal (18–25 cm), cranial in sublumbar fossa: rumenotomy (essential to be
as far cranial as possible in large-framed cow and short surgeon);
2. left flank abomasopexy (Utrecht technique) or exploratory laparotomy (25 cm);
3. low flank incision in recumbent cow or heifer for caesarean section, where it is
anticipated that it will be difficult to bring uterine wall to flank (35 cm);
4. standard caudal left flank (35–40 cm) and
5. oblique flank incision (35–40 cm) for caesarean section in standing animal.
Technique
• paravertebral analgesia (T13, L1 and L2, see Section 1.8, pp. 22–26) or
local infiltration (see Section 1.8, pp. 26–27)
• clip, scrub and surgically prepare a wide area of left flank including at least
30 cm around proposed incision site (see Figure 3.6)
• drape with sterile cloths or rubber drape with appropriate window
• make paracostal incision 15 cm long about 5 cm behind last rib, starting
10 cm below lumbar transverse processes
• incise skin in single movement and continue scalpel incision through sub-
cutaneous fat and fascia to expose abdominal wall musculature
Abdominal surgery 83
• insert blade of straight scissors at angle of 45° to surface and into external
oblique abdominal muscle, which is separated by blunt dissection
• make 7 cm long scalpel incision through internal oblique muscle to expose
underlying transverse fascia
• make small incision with scissors through this fascia to reveal parietal
peritoneum beneath a variable amount of loose fat
• pick up parietal peritoneum with rat-tooth forceps and make small vertical
incision with scissors
• extend incision through internal oblique, transverse fascia and peritoneum
with scissors to correspond to length and direction of skin incision. Air rushes
audibly into abdominal cavity at this point creating pneumoperitoneum,
and contact surface of ruminal wall (unless adhesed) drops away as
abdominal wall moves laterally. (Occasionally some pneumoperitoneum
is present before surgery, e.g. in traumatic reticulitis.)
Left side of abdominal cavity and part of right side may now be explored (see
Figure 3.7).
parietal peritoneum
1
4 2
rumen LEFT RUMINAL WALL left kidney
3
spleen descending colon uterus & ovaries
Figure 3.7 Flow diagram of left flank exploratory examination. As in right flank
approach (see Figure 3.8) entire accessible part of abdominal cavity should be rapidly
checked in any abdominal disease. Start from left ruminal wall with palpation of
parietal peritoneum (1), then caudal abdomen (2) and the right side structures
(3), before concentrating on left flank and left cranial and ventral regions (4).
84 Chapter 3
Visible features
• check volume and colour of peritoneal fluid; normal colour is pale yellow.
A slight pink tinge may be due to contamination of some blood from
incision site. Presence of any floccules, usually purulent, is abnormal and
indicates an infective focus in the visceral or parietal peritoneum. Possibly
also an associated objectionable odour.
• run fingers over surface of both parietal and ruminal (visceral) peri-
toneum adjacent to incision: surface should be smooth. Irregularities may
be in form of discrete adhesions or generalised lesion (‘sandpaper-like’)
consistent with chronic peritonitis.
Palpable features
• introduce the right hand and arm to make systematic examination of the
abdominal cavity (see Figure 3.7)
• pass right hand ventrally to check for possible LDA, and also cranially for
adhesions between reticulum and diaphragm or liver, or (rarely) between
rumen and abdominal wall, suggestive of traumatic reticulitis
• presence of abdominal adhesions may be of recent origin and significant, or
may be longstanding and purely an incidental finding. Recent adhesions
(less than one week) tend to be broken down easily, though this may cause
localised pain. Older adhesions tend to be difficult or impossible to break
down and pain is absent
• assess texture of peritoneal surface in different areas at early stage of
exploration before repeated movement causes iatrogenic roughening
• structures palpated on left side (see Figure 3.1) should include: rumen,
reticulum, spleen, left border of liver, diaphragm, apical beat of heart, left
kidney through perirenal fat, path of ureters (normally non-palpable unless
thickened), bladder including bladder neck, uterus, left and right ovaries,
and descending colon
• pass right hand and arm to right abdominal wall by directing it caudal to
the attachment of the ruminal wall to the abdominal roof, and ventral
to left kidney and descending colon, thereby avoiding possible iatrogenic
spread of infection from left side of abdomen
• structures now accessible include: left kidney, spiral colon, duodenum,
jejunum and ileum, and caecum (see Figures 3.1–3.3).
Discussion
Structures too distant for palpation by veterinarian of average stature in
adult Holstein Friesian cow include: abomasum, much of the visceral surface
of liver and gall bladder, and parts of the omasum, some of the small intestine
(jejunal loops) and large intestine (colonic coils).
Abdominal surgery 85
Visible features
Note greater omentum below incision, with descending duodunum passing
caudally in the omentum.
Palpable features
• pass left hand and arm ventrally to palpate abomasum, note some mobil-
ity is possible and abomasum may be grasped and pulled upwards towards
incision
• appreciate cranially visceral surface of liver (note any rounded edges,
abscesses or surface irregularity) with dependent gall bladder (normal
size up to 10 × 6 × 4 cm), and insert hand between liver and diaphragm to
palpate cranial hepatic surface, e.g. discrete abscessation
• pass hand along lateral body wall with palm outwards and ventrally locate
reticulum (note any adhesions, or foreign bodies) beyond abomasum and
greater omentum
• check contact area of reticulum with diaphragm (possible adhesions)
• note mesoduodenum is dorsal to duodenum, and deep to this area is the
perirenal fat (right kidney)
• palpate, caudal to right kidney, the right surface of left kidney, both
structures being slightly to right of midline due to pressure from rumen.
Right kidney is dorsal to cranial part of descending duodenum, to right
of mesoduodenum. Left kidney lies adjacent to middle part of descending
duodenum entirely within the supraomental recess
• pass hand caudal to caudal edge of greater omentum which runs approx-
imately midway between last rib and tuber coxae
• palpate structures in this space, which include numerous coils of
jejunum and ileum, as well as spiral colon, caecum, which is very vari-
able in size, and dorsally ascending colon and descending colon (see
Figure 3.3)
• some intestine which may be exteriorised for examination includes much
of jejunum (except cranially), apex and body of caecum, and more ventral
loops of ascending spiral colon
• note, suspended from midline (palpable but cannot be exteriorised),
descending colon and part of ascending colon, passing into pelvic cavity
together with bladder, uterus and ovaries
86 Chapter 3
root of body of 3
mesentery caecum abomasum visceral surface
2
of liver
reticulum
spiral colon
gall bladder
abdominal wall
cranial surface
diaphragm of liver
Figure 3.8 Flow diagram of right flank exploratory laparotomy. Entire accessible
abdominal cavity should be checked in any case of suspected abdominal disease.
In a case of LDA the abomasum is not found on right side (step 1), but against left
abdominal wall. Nevertheless steps 2 and 3 should be followed to rule out co-existing
traumatic reticulitis or liver abscessation. In suspect cases of small or large intestinal
disease or displacement, step 4 should be followed, but exploration of remainder of
abdominal cavity should be carried out at a later stage.
1
2
A B
Figure 3.9 Transverse section through flank (diagrammatic) showing two methods
of closing laparotomy wounds. (A) Recommended three layer closure; (B) single layer
figure-of-eight closure.
1. peritoneum; 2. transverse fascia/muscle, 3. internal and external oblique muscles;
4. skin.
Discussion
The above technique achieves optimal apposition of peritoneum, muscula-
ture and skin, and the cosmetic result is pleasing. Any buried deep sutures
should be of absorbable material in view of probable human consumption of
the carcass.
3.4 Rumenotomy
Indications
• removal of foreign body in traumatic reticulitis or reticuloperitonitis
• gross severe rumen overload (‘grain overload’) involving acidosis follow-
ing sudden ingestion of large volume of concentrates (barley etc.), and
rarely, recent ingestion of toxic plant material (e.g. yew). Latter is usually
fatal
• exploratory surgery, e.g. in chronic intermittent rumen tympany
Traumatic reticulitis
Incidence
Traumatic reticulitis is usually encountered sporadically in cattle over
two years old, though occasionally farmers may experience a series of
cases in a few weeks or months, associated with ingestion of particular
batch of feed. Cases are more common in indoor winter feeding period on hay
or silage.
Abdominal surgery 89
5
4
3
2
Aetiology
Most foreign bodies ingested by cattle fail to penetrate rumino-reticular wall
and remain in rumen (small stones etc.) or are eventually voided in faeces.
Long metallic foreign bodies such as pieces of wire, needles or nails (typically
chopped wire strands from decomposing lorry or car tyres, or rusting fencing)
and rarely broom bristles etc., are thrown forwards by ruminal-reticular con-
tractions into the honeycombed reticulum which contracts and the foreign
body may penetrate the mucosa. Common site is the cranial and ventral
reticular wall. Penetration to depth of 5–7 mm results in perforation of the
visceral peritoneum, and point then traumatises opposing parietal peritoneum,
usually the diaphragm and occasionally the abdominal wall, spleen or liver
(see Figure 3.10).
Pain arises from irritation to peritoneum and may be temporary, the
foreign body dropping back loose into the reticular wall or lumen, either
to repenetrate at another point or to pass further down the alimentary
tract where further trouble is most unlikely. At site of penetration an acute
localised inflammatory reaction with exudate becomes slowly organised
as an adhesion, or abscess. In others cases the foreign body slowly advances
further, persistent pain is apparent for several days, and the foreign body
may eventually enter the thorax and heart, liver, spleen or abdominal wall.
Sequelae of reticular foreign body penetration and their signs are multiple,
potentially fatal, and are discussed on page 91.
90 Chapter 3
Clinical signs
Acute stage
Sudden onset of complete anorexia, dullness and slightly apprehensive appear-
ance, severe drop in milk yield, stiff gait, slightly hunched back, mild ruminal
tympany, possibly some pneumoperitoneum, and slight expiratory grunt.
Many cases are in early post-partum period. Animal may prefer to stand with
forequarters relatively elevated. On lying down there may be obvious grunt.
When forced to move animal may show stiff gait, abducted elbows and tucked
up abdomen. Faeces are hard and reduced in volume. Rectal temperature
initially elevated to 39.7–41.1°C then falling to 39.2–39.4°C with little or
no ruminoreticular activity. Urination may be initially suspended due to
pain in adoption of appropriate stance, followed later by passage of large
volume of urine. Ballottement or percussion of cranioventral abdomen
may be markedly resented, and pinching of withers may elicit a grunt and
reluctance to depress the spine.
Chronic stage
This starts five to seven days after acute stage and is not striking or charac-
teristic. Appetite is improved but not normal, often preferring concentrates
to roughage. Slight ruminal tympany is evident. Stance is almost normal
although slight stiffness is possible, while ruminal movements are present but
of reduced intensity.
Diagnosis
Usually easy in early stages of acute case and is based on sudden onset of
pyrexia, localised pain and ruminal stasis. In chronic cases diagnosis is often
difficult. Sporadic episodic flare-ups occur with persistent moderate pyrexia,
abdominal pain, anorexia and lowered milk yield. Such recurrent attacks
justify exploratory laparotomy and rumenotomy. Sixty per cent of reticular
punctures completely recover spontaneously, 30% remain as localised areas
of chronic peritonitis, and 10% develop serious sequelae.
Radiography, ultrasonography, laparoscopy, peritoneoscopy, abdomin-
ocentesis, haematology (leucocytosis with left shift) and metal detector are
ancillary aids to diagnose traumatic reticulitis. Such specialised diagnostic
methods have obvious limitations even in the difficult chronic case:
Conservative treatment
Often, as signs are assessed over a few days, conservative medical treatment
is instituted; forequarters should be elevated 45 cm with boarding or earth,
and systemic antibiotic therapy given for three days. Magnetic probangs
(Eisenhut model) and magnets have given disappointing therapeutic results.
Many cases respond completely, some temporarily, to any conservative
treatment.
Technique of rumenotomy
Rumenotomy is the preferred treatment for acute traumatic reticuloperitonitis,
and is also indicated in suspicious cases of chronic disease which are non-
responsive to conservative treatment including chemotherapy, administration
of a permanent magnet, and management change.
Site is in left flank as described in exploratory laparotomy (see Section 3.2,
pp. 79–84). Length of incision should be 18–25 cm, but varies somewhat
92 Chapter 3
• screw the Weingart frame into the dorsal commissure of the skin incision
• push ruminal contents inwards at intended rumenotomy incision
• grasp rumen wall dorsally and about 15 cm ventrally with the two pairs of
forceps, exteriorise and fix to two rings at top and bottom of frame. This
brings out the rumen but does not yet prevent contamination
• place a sterile cloth or rubber drape or shroud completely around the
exteriorised rumen between the frame and the abdominal wall
• incise the rumen just below the dorsal forceps
• insert one of the small ruminal hooks into the ruminal mucosa near the
edge, pull back and clip the rumen onto edge of the frame at eleven o’clock
position, followed by another at one o’clock
Abdominal surgery 93
Figure 3.11 Weingart frame placed to exteriorise and fix ruminal wall with six hooks
and two vulsellum forceps.
• a special rubber cloth with everted stiff cuff surrounding the abdominal
incision is placed over the flank
• exteriorise rumen and make 2.5 cm incision in upper position
• insert rubber-covered hook which is held temporarily by a non-sterile
assistant
• extend incision ventrally to 10–11 cm length
94 Chapter 3
• insert rim of stiff rubber cuff through the incision, whereupon the lips
of the ruminal incision will grip it tightly, and pull of rumen draws rim
against skin of flank
• place a thin rubber sheet with 15 cm elliptical hole between rumen and skin
• place another, similar sheet over the rim and double back the edge of
ruminal cuff to form a seal
Suture method
• suture ruminal wall to skin by simple continuous suture of non-absorbable
material (4 metric) on cutting needle and to rumen with Cushing-type
pattern
• after suturing, check site for a good seal between rumen and skin
• incise rumen starting 2.5 cm ventral to dorsal commissure and ending
3 cm dorsal to ventral commissure
• if rumen is not relatively empty and flaccid, these sutures can possibly tear
out, and in such doubtful cases suture ruminal wall to edge of parietal
peritoneal incision
• for easy handling when working alone, dorsal and ventral parts of
exteriorised rumen may be temporarily fixed to skin by towel clips (13 cm)
for suturing purposes
Regardless of method, the next steps are similar:
• siphon off any excessive fluid with wide bore (3 cm internal diameter)
plastic tubing filled with water, and remove any obstructing solid material
• pass arm cranially and ventrally over U-shaped ruminoreticular pillar and
explore reticulum methodically. Evidence of adhesions already palpated
during intra-abdominal exploration may lead hand to a particular area
otherwise make initial rapid examination of the reticular floor, then of
cranial wall
• identify and examine the cardia, oesophageal groove, and the reticulo-
omasal opening as well as the medial wall: touching of reticulo-omasal
orifice should provoke contraction
• remove loose reticular foreign bodies, but search specifically for pointed
longitudinal foreign body lodged in secondary reticular cells between the
secondary crests which characterise this organ
• search with fingertips as only 1 cm or less length of foreign body may
protrude into lumen. In other cases it can subsequently be confirmed that
the foreign body has passed right through the reticular wall
• it may be helpful to elevate the reticular wall with fingers to assess the
presence of adhesions out of reach on parietal surface, e.g. right side
• palpate reticular wall also for discrete abscesses
• if penetrating foreign body is found, and before its removal note depth
and direction of penetration to consider the likely structures damaged at
this time. This aids prognosis. The wisdom of puncturing and draining
Abdominal surgery 95
Treatment of adhesions
• chronic adhesions: there is usually little or no benefit from breaking down
chronic adhesions, which tend to reform very rapidly
• recent adhesions: do not break down since they may mask and surround
an abscess cavity
Suture method
• after initial cleansing of exposed ruminal surface insert two layers of
sutures and then carry out thorough cleansing of the surfaces
• débride any contaminated tissue from the body wall musculature
• remove the circumferential peritoneal suture
96 Chapter 3
Indications
Chronic recurrent ruminal tympany usually occurs in calves of three to nine
months. Condition causes unthriftiness resulting from reduced feed intake.
Fistula affords symptomatic relief and is rapidly produced. Alternatively,
self-retaining disposable calf trocar (Buff spiral model, 11 cm Kruuse) may be
used for a few days, but requires to be cleaned regularly with metallic trocar
to avoid blockage.
Signs
Slight but progressive loss of condition associated with more or less per-
manent overdistension of rumen. Many such calves eventually recover
spontaneously. Rumination is usually unaffected.
Technique
• paravertebral analgesia (T13, L1, see Section 1.8, pp. 22–24) or local
infiltration analgesia (see Section 1.7, pp. 26–27). Site is upper left para-
lumbar fossa, one third of distance from last rib to external angle of ilium
• clip skin over site 10 × 7 cm and disinfect
• pass stomach tube to relieve any tympany
Abdominal surgery 97
A B
Figure 3.12 One technique of suturing rumen to body wall to create ruminal fistula.
A. four mattress sutures from ruminal wall to skin; B. eight simple sutures to overlap
rumen over skin edges; Fistula of appropriate size may then be made.
• remove oval section of skin 4 × 2 cm, and split muscularis by blunt dis-
section (scissors)
• pick up peritoneum with Allis forceps, incise, and grasp
• exteriorise underlying ruminal wall with second Allis forceps
• place sutures (polyamide) between skin and rumen using interrupted
horizontal mattress pattern or simple continuous stuture for initial fixation
(see Figure 3.12a)
Alternatively, a screw trocar (Buff model) may be inserted through
flank for several weeks as needed. Problems can occur: lumen blockage,
displacement out of rumen, peritonitis
• incise rumen (3 cm) and place four or eight simple sutures to overlap
rumen and skin margin (see Figure 3.12)
• if thought necessary, convert slit into oval by removing portion of wall
slightly smaller than the previously resected skin
This ruminal incision usually heals in three to five weeks following fibrous
tissue proliferation and stricture. A permanent fistula requires a ruminal
incision at least 6 cm long.
Aetiology
Causes include:
• chronic reticulitis commonly with adhesion formation, with signs reflect-
ing poor ruminal contractility subsequent to vagal nerve injury (see
Figure 3.22)
98 Chapter 3
• tetanus
• cancer of oesophagus, oesophageal groove or cardia (alimentary lymph-
osarcoma) is rare cause
• mediastinal lymph node enlargement, nodes resting dorsal to oesophagus
and effectively preventing erutcation, due to chronic systemic lymph-
adenopathy, e.g. pneumonia, or actinobacillosis
• visceral actinobacillosis of oesophageal groove, reticulum or cardia, usu-
ally in cattle between one and a half and three years old
• thymic lymphosarcoma in cattle aged twelve to eighteen months
Diagnosis
Usually difficult. Non-response to antibiotherapy usually eliminates actinoba-
cillosis. Some cases recover spontaneously, but many persist and exploratory
laparotomy and rumenotomy may sometimes be justified, i.e. valuable cattle
with considerable future breeding potential.
Anatomy
The abomasum normally lies on the abdominal floor, and its relations depend
on the degree of distension of rumen, reticulum and omasum, and their con-
traction. The abomasum has the fundic and pyloric regions. The distinction
between fundus and corpus (body) is imprecise and of no clinical interest. The
narrower pyloric part passes transversely and possibly slightly craniad along
the right body wall, to pass into the pylorus which lies caudal and lateral to
the ventral part of the omasum beneath ribs 11–12.
Aetiology
Left displacement of abomasum (LDA), right dilatation and displacement
(RDA), and abomasal volvulus probably have a common aetiology despite
differing symptomatology. LDA aetiology involves abomasal fundus hypo-
motility and hypotonicity resulting in delayed emptying. Factors include:
Signs
• dairy cattle, winter-housed period and usually within six weeks of parturi-
tion, increasing incidence today in calved heifers and calves
• relatively sudden drop in yield and selective anorexia, refusing most
concentrates
• reduced or absent ruminal movements and reduced rumination
• animal fairly bright and without abdominal pain except in rare case
(with peptic ulceration, perforation and acute localised peritonitis)
• mild constipation initially
• afebrile (except with secondary peritonitis or concurrent disease)
• frequently secondary ketonuria with positive Rothera’s test (milk) and
sweet smell in expired air
• mild hypochloraemia, hypokalaemia and slight metabolic alkalosis possible
• possible recent history of dystocia, milk fever, metritis or mastitis
• progressive and accelerating loss of condition
Diagnosis
Auscultation of left flank pathognomonic: high-pitched metallic tinkling
sounds from left flank over middle area bounded by ribs 10–13. Corres-
ponding area of resonance detected by applying stethoscope and by flicking
forefinger against rib cage; echo-like sound ‘steelband effect’ or ‘ping’ is
quite different from dullness appreciated with rumen closely applied to left
body wall. In doubtful case ballotte ventral ruminal sac with right knee while
auscultating left flank over ribs 10–12 (greater frequency of abnormal
sounds).
Occasionally a slight distention of dorsocranial part of left paralumbar
fossa just behind rib 13 results from severe abomasal tympany.
Rarely can LDA be detected on rectal examination as a tympanitic viscus
between left dorsal sac of rumen and left flank.
Differential diagnosis
Differential diagnosis of left flank resonance: hypotonic form of vagus indiges-
tion may reveal peritoneal fluid and gas
In rare difficult cases a ‘liptac test’ can be used to confirm the diagnosis.
An 8 cm 14 gauge needle is pushed through the body wall into the centre
of the area defined by a ‘ping’. Centesis is used to collect some fluid. A pH
less than 3.5 indicates a displaced abomasum; a pH greater than 5.5 suggests
the ‘ping’ comes from the rumen. An orogastric tube can also be passed
into the rumen to help differentiate a rumen ‘ping’ from that due to LDA. By
ultrasonography the LDA can be visualised as a fluid- and gas-filled viscus
covering the rumen.
100 Chapter 3
Conservative technique
Indicated in recent cases where economic factors (cost of surgery) are import-
ant. Treatment is primarily replacement by rolling.
• cast cow on right side (Reuff’s method, one person restraining head, two
on ropes)
• turn over on to left side and while turning ballotte ventral abdominal wall
firmly in an attempt to move abomasum into midline position, using knee
to push anti-clockwise
• alternatively cast cow on back in dorsal recumbency and move from
45° right lateral to 45° left lateral position, ‘shaking’ abomasum back into
normal position
• finally, in either rolling method, turn cow into left lateral recumbency and
maintain in this position for five to ten minutes to permit organ to evacu-
ate excessive gas
• check absence of abomasum from left side on auscultation and finger
percussion
• inject calcium and dextrose i.v.
• re-introduce concentrates slowly over one week period to cows corrected
of LDA by rolling
• encourage maximal exercise in this period
Some cases of LDA corrected by rolling may at once or soon become cases of
RDA. Many others have a recurrence of LDA within 48 hours and require
rolling again or surgery. Success rate of rolling is about 20%.
Incision site Right flank Left flank Right and Midline/paramedian Paracostal Percutaneous
(Utrecht) left flank fixation (toggle)
1
3
Figure 3.13 Diagram of right flank of cow to show site of laparotomy incision for right
flank abomasopexy.
1. rib 13; 2. abomasal fundus and body; 3. flank incision; 4. abomasopexy site (x)
sutured to body wall.
Complications
Post-operative complications include:
Figure 3.14 Abomasopexy from the left side using Utrecht method. Continuous
suture has been placed through greater omentum at insertion onto abomasum in left
flank. Suture is then pushed through ventral body wall just right of midline using a long
straight needle.
Midline approach
Reposition and fixation present few difficulties. Surgery may be performed
under sedation (xylazine, i.v. or i.m.) and local analgesia, or under GA. Animal
should be supported by straw bales laterally, and hind legs should be roped
away from operative site. A stockman, restraining head, keeps forelegs away
from surgical field, operator’s head and hands.
3
9
8
5 2
7
• clip and disinfect the ventral abdomen to right of midline between xiphoid
and umbilicus, marking position of right abdominal vein
• give 45–50 mg xylazine i.v. and cast cow (e.g. by Reuff’s method) on right
side
• turn quickly into dorsal recumbency and extend and tie hind legs, place
straw bales against flanks for stability
Abdominal surgery 107
• assistant kneels in front of udder from left side while surgeon confirms by
auscultation the presence of tympanitic abomasum ventrally
• trocar and cannula (Kruuse UK Ltd, Jorgensen Labs, Colorado, USA)
are inserted firmly through skin, musculature and peritoneum about a
hand’s-width caudal to xiphoid and similar distance right of midline (see
Figure 3.16)
• pull out trocar and insert toggle, having confirmed entry into abomasum
(gas always escapes and acidic pH can be checked with dipstick)
B
cm
15
8 cm
A
D D
Figure 3.16 Abomasal ‘toggling’ procedure through skin of ventral cranial body wall.
A. ventral view showing puncture sites distal to xiphisternum (B), and to right side
between midline and right mammary vein (D).
108 Chapter 3
Figure 3.16 (cont’d) B. puncture by trocar and canula with first toggle in place;
C. removal of trocar and insertion of toggle through canula; D. tying together of
sutures from each toggle with space for insertion of two fingers.
Abdominal surgery 109
small lobes of greater and lesser omental fat overlap the abomasal border.
Abomasum is thicker and denser at this point (pyloric antrum), which is
the pylorus, located below rib 10, about half-way down body wall
Animals with RDA may make spontaneous recovery but many become
progressively duller, and some develop bradycardia. Prognosis is guarded.
Figure 3.17 Three forms of right abomasal displacement and torsion and their
manipulative correction. (From Dirksen, Gründer & Stöber, 2002.)
A. left (anti-clockwise from rear view) 360° torsion and direction of manual correction;
B. left 180° torsion, and correction; C. simple right-sided abomasal displacement
(possibly with up to 90° rotation). (From Dirksen, Gründer & Stöber, 2002.)
Abdominal surgery 113
• impaction
• abomasal tympany and volvulus in calves
• ulceration (with or without perforation)
Abomasal impaction
Introduction
Impaction may be primary, as in calves following incorrect feeding with
excessive roughage and an inadequate water intake. Impaction may also be
secondary to surgical correction of abomasal volvulus, or to lymphosarcoma
and adhesion formation in the cranial part of the abdominal cavity.
Treatment
• perform exploratory surgery through a right midflank incision
• break down abomasal contents manually
• give paraffin oil (5 litres, with 20 litres of water) by an orogastric tube
once, or repeated 24 hours later
Some cases may slowly resolve. Abomasotomy through a right paramedian
incision may be necessary in advanced cases.
Signs
Seen in calves typically at six weeks to three months shortly after bucket milk
feeding, signs include obvious discomfort with head extended, mild colicky
signs and right flank tympany, later depression and spread of tympany to
involve the left flank. Systemic signs rapidly become severe and calves can die
within a few hours.
Differential diagnosis: rumen tympany (unlikely in this age group), caecal
dilatation and dislocation, jejunal volvulus or intussusception
Treatment
Recumbent calves with circulatory collapse should generally be euthanised.
Less severe cases:
Abomasal ulceration
Introduction
Common condition in slaughterhouse statistics, both in calves and adults.
Younger cows tend to be affected within four weeks of parturition. Abomasal
ulcers rarely cause significant clinical disease.
Signs
• abdominal pain, which is not only associated with peritonitis
• calves show abomasal dilation with ulceration (painful palpation)
• melaena and pale mucous membranes (type 2)
• pyrexia and tachycardia in cases with peritonitis
• abdominocentesis (see Section 3.16, p. 130) useful to confirm peritonitis
e.g. acute fatal cases involving ruptured omental abscessation
Treatment
• type 2 ulcers require whole blood transfusion if PCV drops below 15 vols%
• treatment of peritonitis requires systemic antibiotics
• i.v. fluids
• exploration in left flank LDA: correction of left abomasal adhesions, rarely
is surgical resection of ulcer necessary
• correction of primary disorder
• pyloromyotomy may improve prognosis in calves with abomasal dilation
and ulceration
Figure 3.18(b) Transverse section through abdomen: (1) dilated body of caecum,
(2) distended loops of spiral colon, and (3) sometimes also small intestine are
palpable in caecal retroflexion; (4) rumen and (5) left kidney
Treatment
Medical management may be indicated in some cows with dilatation.
Surgical approach:
• site of incision upper right flank, and relatively more caudal than for RDA
• exteriorise caecum and examine carefully for necrosis and commencing
gangrene
118 Chapter 3
Prognosis
Prognosis is good (dilatation) or guarded (dislocation) and recurrence rate
is up to 20%. Typhlectomy (partial caecectomy) is rarely indicated but
relatively simple to perform. Cow copes well with caecum of reduced capacity.
Introduction
Intussusception (invagination or telescoping of bowel) occasionally affects
small intestine ( jejunum, ileum). Predisposing causes are unknown but the
condition is not always associated with hyperperistalsis, enteritis or diarrhoea.
Any age group, from calves to older cows, may be affected, but calves appear
predisposed. Complete bowel obstruction results. Sometimes a double intus-
susception (five layers of bowel wall superimposed on each side) develops.
Signs
• sudden onset of acute abdominal pain
• groaning, kicking at belly, alternately lying and standing, paddling of hind
legs
• within 12 hours acute signs are succeeded by dullness, anorexia, pre-
cipitous drop in milk yield (as in traumatic reticulitis)
• initial tachycardia (heart rate 120/min) disappears, while melaena may
be replaced by total absence of faeces
• stance may be persistently abnormal after 24 hours, animal adopting
rocking-horse position, or may lie down and groan
• site is usually distal jejunum, or rarely jejunoileal junction with invagin-
ated section (intussusceptum) passing into caecum or into proximal colon
Condition may last five to eight days, with slow deterioration and death from
metabolic effects of total obstruction in which plasma chloride progressively
falls, with haemoconcentration and dehydration.
Diagnosis
Diagnosis depends on rectal palpation of several distended small bowel
loops, about 5 cm diameter, or possibly a firm, painful and slightly mobile,
fist-shaped mass relatively low on right side or just cranial to pelvic inlet. In
Abdominal surgery 119
Treatment
It is alleged that some cases recover spontaneously after sloughing the intus-
susceptum, but this has never been seen by the authors.
Introduction
Obstruction, rarely strangulation, may follow passage of bowel through tear
of peritoneum between vas deferens and abdominal wall, following castra-
tion procedure in which excessive traction on, and recoil of, spermatic cord
results in adhesion of cord or peritoneal fold around bowel (‘gut-tie’). Jejunum
is usually involved and condition develops slowly with signs related to
gradual lumenal occlusion (see Figure 3.19).
Signs
• anorexia, dullness, reduced passage of faeces and distention of flank
• ballottement of flanks and palpation inconclusive
• rectal palpation often permits easy diagnosis by recognition of distended
small intestine and one or more abnormal cord-like structures near inguinal
ring (see Figure 3.19)
• diagnosis depends on exploratory laparotomy following suggestive history
and signs
• problem is usually located near internal inguinal ring and (due to anatom-
ical distribution of small intestine) on right side
Treatment
• gentle rectal traction on adhesed spermatic cord stump is fairly simple
to perform and may lead to rapid recovery (90% success) but can be
hazardous and not recommended for inexperienced persons who should
appreciate the risk of tearing the bowel wall
• perform right flank laparotomy in standing or left laterally recumbent
animal
• section or resect the adhesed spermatic cord or vas deferens with scissors
using blind palpation
Abdominal surgery 121
A
B
Figure 3.19 ‘Gut-tie’ involving recoiled stump of ductus (vas) deferens adhesing
around and occluding lumen of small intestine, resulting in bowel obstruction
(compare with Figure 1.11).
A. abnormal stump of ductus (vas) deferens; B. normal position of ductus (vas)
deferens.
3.12 Peritonitis
Introduction
Peritonitis is usually secondary to a diffuse or localised primary condition.
Causes may be perforation of an abomasal ulcer, rupture of a reticular wall or
hepatic abscess, reticular perforation of a foreign body, infection following
uterine rupture, or the introduction of infection at caesarean section. Some
cases follow a breakdown of surgical asepsis.
122 Chapter 3
Treatment
Specific problems arise in treatment of peritonitis, which involves infection
in a transcellular space where antibiotics cannot reach the concentrations
found in tissues and serum. Generalised purulent peritonitis has a hopeless
prognosis, and the animal should be euthanised.
Apart from appropriate antibiotics (see below), treatment in early acute
cases may include:
Introduction
Umbilical herniation is a very common surgical condition in the Holstein
and other cattle breeds. It may be inherited by a dominant character with
incomplete penetrance, or be conditioned by environmental factors. It is
unlikely to be sex linked.
Complication of herniation is frequently coexistent with umbilical abscessa-
tion. Sometimes abscess may be involved in primary aetiology. Surgery may
be contra-indicated in large simple (i.e. non-infected) umbilical herniae of
animals intended as breeding stock (e.g. bulls), because evidence suggests
the condition is inherited (see Section 1.16, pp. 52–53).
Abdominal surgery 123
Signs
An exceptionally large umbilical hernia is evident at birth, but the majority
are first noticed a few weeks later. The peritoneum-lined hernial sac may
measure 3–12 cm diameter. Corresponding hernial ring is typically about
1–7 cm long and 1–3 cm wide.
Contents of hernial sac are peritoneal fluid, greater omentum, and in larger
cases, the abomasum. Small or large intestine is sometimes involved.
Diagnosis
Diagnosis is based on the history, palpation of the swelling and the adjacent
ventral abdominal wall for signs of intra-abdominal involvement. Pain on
palpation is suspicious of a septic process (see Figure 3.20) or incarceration.
Ultrasound investigation may be considered to define the contents of an
umbilical swelling and intra-abdominal involvement.
B E
D
A
C
• calves aged three to six months with hernia still present, possibly enlarg-
ing, since spontaneous resolution is now unlikely
Pre-operative complications:
Surgical technique
• reduce ruminal volume in older calves by 24 hours’ starvation to reduce
post-op pressure on surgical wound, also to reduce degree of ruminal
tympany during surgery, both during GA and LA
• obtain deep sedation and perform local analgesic infiltration of area
with or without anterior epidural analgesia, or use GA (see Section 1.9,
pp. 36–39)
• place calf in dorsal recumbency, preferably raised from ground, and
positioned with straw bales laterally, and with legs fixed cranially and
caudally remote from surgical field
• in male calf irrigate and pack preputial cavity
• clip extensive area of ventral abdominal wall, scrub and disinfect three
times
• ensure availability of sterile prosthetic mesh material for hernias where
ring exceeds 10 cm diameter (see below)
• make elliptical skin incision around hernial base, continue along midline
well cranial and caudal to limits of hernial ring
• dissect subcutaneous tissue bluntly to expose the hernial sac
• continue blunt dissection down to reveal edge of hernial ring, carefully
incise hernial sac at junction of body wall and sac and insert finger into
abdominal cavity
• resect sac, and circumferentially a thin strip of the hernial ring, as long as
there are no adhesions of gastro-intestinal organs to parietal peritoneum
and umbilicus
• attempt gently to break down any adhesions between hernial sac and
abdominal contents. If sac cannot be incised without damaging contents,
incise longitudinally through linea alba cranial to ring and remove sac
together with herniated viscera after any necessary enterectomy
• bring together longitudinal edges of opening for suturing
• avoid undue tension by lengthening the ring cranially and caudally,
converting the oval shape into a long ellipse
• if ring closure is likely to result in excessive suture tension, make
longitudinal incision through external sheath of the rectus sheath, about
Abdominal surgery 125
3 cm lateral to left and right of midline. Incision should not extend into
longitudinal muscle fibres or the internal rectus sheath
• close body defect wall by simple interrupted sutures of absorbable material
such as polyglactin 910, PGA or PDS starting at commissures of the wound
• use a near-far-far-near pattern in large hernias
• if approximation for tying knots is difficult, preplace sutures and secure
ends loosely with haemostatic forceps, and then use steady traction on all
the sutures finally to close the ring
• internal hernial sac may alternatively be reduced into abdomen and edges
of ring apposed in same manner but without penetrating peritoneum
(closed herniorraphy), but recurrence common
• ensure sutures are well covered by subcutaneous tissues closed by PDS 5
metric in continuous pattern. It is essential to bury the deep suture layer
and to avoid leaving potential dead space
• appose the skin edges by vertical mattress sutures (monofilament nylon)
• eliminate dead space by resecting excessive skin tissue
• give systemic antibiotics for three to five days
• clean skin wound with warm dilute povidone-iodine solution after 24
hours, or preferably abdominal wrap for 24 hours confining calf in box for
one to two weeks
• give only water and a little concentrate for the first two days, after which
normal diet is resumed
Vital points in surgical procedure include:
2 1
B D
Technique
It is frequently impossible to avoid inserting the material into the abdominal
cavity, although ideally the internal hernial ring and parietal peritoneum
should be left intact, the hernial sac inverted, and the mesh should be buried
underneath the parietal peritoneum.
• ensure that the size of mesh prepared is slightly larger in area than the
defect
• suture initially to four equidistant points of circumference e.g. caudal,
cranial, left lateral, right lateral. Normally distal contact surface will be
greater omentum
• trim to precise size
• place interrupted simple or vertical mattress pattern sutures into firm
fibrous tissue of hernial ring (see Figure 3.21)
• bury mesh with layer of connective tissue. Mesh must not lie
subcutaneously
• avoid any residual dead space by resection of excessive skin before inser-
tion of interrupted vertical mattress skin sutures
Abdominal surgery 127
Infection of the umbilical vein is serious, as sepsis may extend into the
liver, permitting haematogenous spread to lungs, joints (‘joint ill’) and other
organs. Resection is then contra-indicated. If no spread has occurred, and
the vein is involved in septic thrombophlebitis, marsupialisation through
the ventral abdominal wall under GA may be attempted in valuable stock.
In most cases of septic thrombrophlebitis and septic urachitis, resection is
simple under GA. Surgical excision of the infected urachus, arteries or vein
should be complete. The stumps of healthy tissue can, at the surgeon’s discre-
tion, be oversewn with greater omentum. Sometimes small area of bladder
wall continuous with pervious urachus is resected and the opening closed by
continuous inversion suture.
Post-operative treatment: systemic antimicrobial therapy for five days.
Alimentary tract neoplasms are, with the exception below, uncommon. Some
are seen in the oral cavity (fibroma, sarcoma) requiring differential diagnosis
from actinobacillosis and actinomycosis. Intestinal neoplasms have occasion-
ally been incriminated in the pathogenesis of intussusception, and are then
amenable to removal via bowel resection and anastomosis. Lipomata are
sometimes the cause of vague indigestion and weight loss in adult cattle,
especially the Channel Island breeds, and are rarely treatable.
128 Chapter 3
Clinical signs
These may have four forms:
Diagnosis
Careful inspection is made of oropharynx with mouth gag (Drinkwater
pattern), torch and manual exploration. Endoscopy of oesophagus if available.
Some cases with clinical signs, including chronic tympany referable to
ruminoreticulum, undergo exploratory laparotomy (no significant findings)
and, more usefully, rumenotomy when one or more large fungating and
ulcerating masses up to 12 cm diameter may be detected in or near the
oesophageal groove and cardia.
Complete removal of ruminoreticular lesions with resolution of the clinical
signs is impossible due to extensive mural infiltration. Biopsy material may
Abdominal surgery 129
be taken for diagnostic pathology. Such cases are almost invariably found
retrospectively to have lesions in the oropharynx.
The prognosis is hopeless and affected cattle should be slaughtered.
Introduction
Vagal (vagus) indigestion is a chronic ruminoreticular condition of increas-
ing abdominal distension and low-grade ruminoreticular activity, thought
to be associated with dysfunction of vagal nerve branches supplying the
forestomachs. Dysfunction involves hyper- or hypomotility, and often results
in a secondary abomasal tympany.
Anatomy
The left and right vagus nerves (see Figure 3.22) form dorsal and ventral
oesophageal trunks and supply direct branches to the ruminoreticular wall,
including the sulcus and reticulo-omasal orifice, omasum and abomasum.
Section of both trunks completely abolishes motor activity of the fore-
stomachs. Section of the dorsal branch alone results in almost complete, but
not inevitably permanent, paralysis of the rumen, with lesser effects on the
reticulum. The effects of section of the ventral branch are less predictable and
range from little to almost complete forestomach paralysis.
6
5
7
3
4
2
Figure 3.22 Vagal trunk innervation of bovine stomachs, viewed from right side.
1. dorsal sac or rumen; 2. reticulum; 3. omasum; 4. abomasum; 5. cardia; 6 & 7 dorsal
and ventral trunks of vagus lying alongside oesophagus at cardia.
Note that abscessation in reticular wall (x) is liable to interfere with innervation,
particularly of the omentum and abomasum. Dorsal vagal trunk (6) primarily
innervates rumen. (modified from Dyce & Wensing, 1971.)
130 Chapter 3
Clinical signs
Signs develop following alleged injury to the vagal nerves either in the
thoracic mediastinum or in the cranial abdominal cavity, commonly due to
extensive peritonitis secondary to traumatic reticulitis.
Treatment
Exploratory laparotomy and rumenotomy are indicated to check abdominal
cavity between cranial surface of reticulum and diaphragm. Rumenotomy
may rarely reveal lesions of actinobacillosis, which is amenable to treatment:
sodium iodide i.v. streptomycin and dihydrostreptomycin (Devomycin D®,
Norbrook), on days one, three, five, seven and nine or broad spectrum antibi-
otics (tetracyclines) systemically.
Cases with massive adhesion formation involving vagal nerves: any treat-
ment is purely palliative but fluids may be given for some days. Lancing of
perireticular abscess may temporarily or completely solve problem.
Prognosis in most adult chronic cases is poor.
3.16 Abdominocentesis
Abdominal fluid may be collected (‘belly tap’) for diagnostic purposes,
generally for confirmation of a suspected peritonitis or abdominal bleeding
(e.g. perforated abomasal ulcer).
Technique
• clip and surgical scrub (diluted povidone-iodine) right ventral abdominal
wall cranial to umbilicus over most pendulous part (cranial quadrant) or
medial to the fold of the flank and ‘milk vein’ (caudal quadrant), in each
case 5 cm from midline (see Figure 3.23)
Abdominal surgery 131
3
1
Figure 3.23 Possible site for abdominocentesis on right side of abdominal wall in
angle between right abdominal (‘milk’) vein (1) and stifle fold (2). Arrow shows site of
needle puncture; (3) shows level of umbilicus.
Discussion
Fluid may be collected in EDTA tubes for a total white blood cell count,
or sterile tubes for culture. Visual inspection should alone differentiate
conditions such as diffuse peritonitis, haemoperitoneum and uroperitoneum
from normal fluid.
132 Chapter 3
Transudate: clear, colourless, low protein (< 2.5 g/litre), low cell count
Exudate: discoloured, turbid, high protein (> 2.5 g/litre) high cell count,
frothy on shaking
Indications
Estimation of Cu, and trace element concentration; diagnosis of fatty liver
and other hepatic pathology.
Technique
• clip and disinfect area 15 × 15 cm, centred on 11th (10th in very
long-backed cattle) right intercostal space and 20 cm ventral to vertebrae.
Check site by percussion for area of hepatic dullness (see Figure 3.24)
• produce local analgesia of skin and intercostal musculature by infiltration
of 5–10 ml 2% lignocaine
• make 1 cm stab incision in skin and musculature
1
2
4
R13
R12
R11
R10 5
Figure 3.24 Diagram of right side of abdominal wall of cow, showing site of hepatic
dullness. Cranial boundary is usually around rib 9. In severe hepatomegaly caudal
border may be palpable behind last rib. Site for hepatic biopsy is about one third of
distance down rib cage. (From Smart & Northcote, 1985.)
1. lung; 2. liver; 3. right kidney; 4. gall bladder; 5. phrenico-costal line; X site of liver
biopsy.
Abdominal surgery 133
Complications
• accidental entry into hepatic vessel – immediate bleeding from cannula.
Avoid by stopping advance of cannula should any firm structure (namely
perivascular fibrous tissue) be encountered, and changing direction slightly
• accidental entry into hepatic abscess with gross peritonitis
• localised peritonitis – dirty technique
• wound infection – dirty technique
Introduction
Anal and rectal atresia (imperforate anus) in the calf are rare, anal atresia
being more frequent. Inheritance of this lethal defect in cattle is not estab-
lished. Other defects e.g. taillessness and spinal dysraphia may co-exist.
Diagnosis
Usually made at two to three days old unless stockman has made meticulous,
neonatal examination. Absence of faeces draws attention to calf which may
have slightly distended abdomen.
Perineum has a scar indicative of anal orifice. In anal atresia scar may
overlie a slight bulge of the subcutaneous tissues, and becomes more pro-
nounced on increased intra-abdominal pressure, applied by pushing on the
flanks or by spontaneous tenesmus. Absence of such a bulge suggests that
rectal atresia may also be present.
134 Chapter 3
Surgery
• operate as soon as possible under caudal epidural analgesia (1 ml 2%
lignocaine plain)
• cleanse and clip area 10 cm diameter around anus
• remove 1 cm diameter circle of skin over anal scar
• retract skin edges with Allis forceps held by assistant
• in anal atresia a distended blind-ended rectum is easily located by digital
exploration in pelvic midline
• attempt to suture rectal wall to skin at this stage
• otherwise gently break down surrounding connective tissue and attempt
to exteriorise the caudal portion of rectum
• place four stay sutures dorsally, ventrally and bilaterally into rectum to
maintain in position and then incise this vertically for 1–2 cm; meconium
will spurt from lumen
• suture rectal margin to skin in simple interrupted sutures of 4 metric
chromic catgut, starting with two dorsal sutures at eleven o’clock and
one o’clock positions, followed by two ventrally at seven o’clock and five
o’clock
• add additional sutures laterally
• avoid as far as possible contamination of subcutis and, more important,
the pelvic cavity
• remove extra-rectal meconium with damp swabs and do not irrigate
wound which could flush infection cranially
• inject systemic antibiotics (five days)
• maintain a lumen, minimum 2 cm diameter, which may require dilata-
tion several weeks later as initial healing results in localised fibrosis
• milk diet for two weeks
• do not use for breeding
Rectal atresia
Treatment
Calves with additional atresia involving the rectum may prove difficult to
assess, and impossible to correct without the creation of a low flank caecal
fistula (preternatal anus) which, though possible experimentally, cannot
be justified on economic, practical and animal welfare grounds. Cicatricial
stricture is a common post-operative result.
Slight rectal atresia, with the rectum terminating 2 cm cranial to the anus,
is treated by careful blunt dissection dorsally involving the mesorectum;
suture to skin as for anal atresia.
Abdominal surgery 135
Introduction
Rectal prolapse seen in young calves, yearling cattle and rarely adults
may be:
Diagnosis
Diagnosis is easily made. Degree of contusion and laceration should be estab-
lished when cleaning the prolapse after inducing caudal epidural analgesia
(see Section 1.8, pp. 27–29).
Treatment
Three forms can be distinguished. All may be performed under epidural
anaesthesia (1–2 ml of 2% lignocaine):
(a) Recent incomplete prolapse without mucosal injury:
•replacement and purse-string suture in subcutaneous peri-anal skin
•insert needle ventrally, emerging dorsally to expose minimum length
of non-absorbable material (e.g. sterile nylon tape) to possible
contamination
•suture should be tied in bow ventrally to permit gradual controlled
slackening
•suture should permit adequate passage of faeces but prevent re-
prolapse, and in a one-month-old calf should permit entry of two digits
136 Chapter 3
Submucosal resection
• make two circular incisions around circumference of the rectum, through
mucosa to the submucosal tissue. The first incision is at the point where
the rectum is reflected on itself, the second is about 1 cm from mucocut-
aneous junction
• join two incisions by another dorsal incision at right angles, and longit-
udinal in direction
• dissect and remove ‘sleeve’ of rectal mucosa between the two circular
incisions
• effect haemostasis by swab pressure and ligation of large vessels
• appose mucosal edges in row of interrupted simple sutures of 4 metric
PDS
• insert purse-string suture as described above
Amputation
Two techniques are available.
Technique 1 Stairstep amputation:
• initially put plastic syringe casing into lumen of rectum and insert cross-
pin fixation with two hypodermic needles to stabilise the prolapsed rectum
during suturing procedure (see Figure 3.25)
• make circumferential incision cranial to necrotic area, but do not cut
inner mucosa and inner submucosa
• create stairstep and amputate 3 cm caudal to initial circumferential
incision
• use extra tissue (inner mucosal layer) to reduce tension on the circum-
ferential suture
• remove hypodermic needles and syringe casing and insert purse-string
suture, as above
Abdominal surgery 137
• take plastic syringe case, open at each end, or proprietary product, and
anchor with circumferential monofilament nylon suture at the most
proximal part of the prolapse
• blood supply is effectively occluded to distal rectum, which sloughs about
10 days later
138 Chapter 3
2
A 1
B 4 3
C 5
Figure 3.26 Repair of prolapsed rectum utilising syringe case or plastic tubing.
A. lumen of rectum; 2. prolapsed wall. B Sutures are placed through skin-rectal
mucosal junction and through holes (4) in the side of plastic tube (3). Second sutures
are placed at 180° to first suture. C Sutures are pulled tight over skin as tube is
inserted appropriately within rectal lumen. Sutures are then tied around the
circumference to occlude blood supply to prolapsed section (5). Prolapsed rectum
and tube drop off some days later as a result of ischaemic necrosis.
Discussion
Careful check must be made at frequent intervals, following technique 2, to
ensure that the plastic case has not become dislodged, and that defaecation
can proceed normally through lumen of case. The method is simple but
messy, and fails if the casing is dislodged for example by contact with pen wall
or other cattle.
Post-operative tenesmus is delayed if the epidural block is made with a
xylazine-lignocaine mixture (see Section 1.7, p. 29) or a longer acting anal-
gesic drug (e.g. Bupivacaine®).
Complications
• immediate excessive stenosis – resuture placing larger diameter hollow
casing into lumen
• excessive haemorrhage – oversew vessel including full thickness of wall
• severe continuous postoperative tenesmus – repeat long-acting epidural
block, produce pneumoperitoneum (insufflating through needle placed
in left paralumbar fossa and attached to Higginson’s syringe), slacken
purse-string suture
Abdominal surgery 139
• anal stricture due to excessive fibrosis – incise anus dorsally and ventrally
through depth of fibrous tissue, and suture cranial commissure to caudal
commissure of wound
Prophylaxis involves attention to the underlying causes (e.g. diet) for the
initial development of the rectal prolapse, especially important in cases where
there are several affected individuals.
Bovine Surgery and Lameness, Second Edition
A. David Weaver, Guy St. Jean, Adrian Steiner
Copyright © 2005 David Weaver, Adrian Steiner and Guy St Jean
CHAPTER 4
Indications
• excessive fetal size (immaturity of dam, double muscling, genetic mis-
matching, and prolonged gestation)
• fetal deformity (e.g. schistosoma reflexus)
• relative or absolute narrowness of pelvic canal (immaturity of dam,
traumatic pelvic deformity)
• fetal malpresentation or posture
• irreducible uterine torsion, uterine rupture, non or incomplete dilatation
of cervical os
• atresia or hypoplasia of maternal vagina or vulva
• certain valuable pedigree breeding programmes where safe delivery of a
viable fetus is paramount, and where management precludes the risks
associated with natural delivery
Until recently hydroallantois and hydroamnion were further indications for
two-stage caesarean section (day one: slow drainage of uterine fluids; day
two: caesarean section). Such cases today have a better prognosis if treated
before onset of recumbency with corticosteroids or prostaglandins, followed
several days later by an i.v. oxytocin drip in refractory cases.
Contra-indications
• cattle in very poor bodily condition (cachectic)
• emphysematous fetus
• most cows with uterine infection
Figure 4.1 Uterine incision (greater curvature) over right hind metatarsus and foot,
having partially exteriorised fetus.
A. uterine incision; B. exteriorised horn; C. left flank incision.
Post-operative care
Continue parenteral antibiotics for five days especially if a dead calf was
delivered, as prophylaxis against infection from retained placenta. Assess
patients in severe shock and recumbency by following parameters: general
appearance, rectal temperature, heart rate and character, colour of visible
membranes, capillary refill time, and willingness to attempt to stand (see p. 41).
In severe cases not only will flunixin meglumine and massive antibiotic
medication be required, but such animals also need large volumes of intra-
venous fluids (e.g. 25 litres).
The calf should be given maternal colostrum as soon as possible by bottle
(teat), or oesophageal feeder. The dam should be encouraged to stand to
permit suckling as soon as possible.
Placenta is usually released and discharged within 24 hours of surgery,
and is a good prognostic sign. Cases with persistent infected discharge at this
144 Chapter 4
Figure 4.2 Utrecht uterine closure method with knot burial. Needle is inserted at
slight angle towards incision and does not penetrate uterine lumen. Sutures are
placed sufficiently close to prevent leakage of uterine fluid. Care is taken to avoid
placenta.
time should receive systemic antibiotics. Farmer should check rectal temper-
ature and recall veterinarian if cow is febrile.
Healing of the flank wound may occur by secondary intention as a result of
intra-operative contamination, and excessive blood and fluid accumulation
between suture layers.
Death rate following caesarean section is low (approximately 10%, even
lower if cows with poor prognosis are not operated), and is due to:
• endotoxaemic shock
• chronic severe intra-uterine haemorrhage (via vulva)
• septic metritis and peritonitis
• cast at oblique angle between right lateral and dorsal recumbency and
restrain legs
• clip and scrub operative field from 12 cm cranial to umbilicus caudally to
udder, and cover body with sterile drape with 30 cm window
• incise skin caudally from 5–7 cm cranial to umbilicus as required
• incise fat, fascia, linea alba and peritoneum longitudinally
• push free edge of greater omentum cranially and exteriorise gravid horn
by traction on fetal limb
• proceed then as for flank incision. Omentum can be drawn over uterine
incision before closing body wall
• suture peritoneum and linea alba with simple continuous or interrupted
appositional mattress eversion suture of PGA or monofilament nylon
(7 metric)
• bury this layer with simple continuous layer of chromic catgut
• suture skin and subcutis with monofilament nylon in interrupted mattress
pattern
Post-operative fertility
Post-operative fertility following caesarean section is lower than fertility
following normal parturition (about 72% compared with 89%). Repeat
operation is relatively common, though the indication is rarely the same.
Comparative data for large series on fertility following embryotomy and
caesarean section is lacking.
146 Chapter 4
Introduction
This condition is typically seen in late gestation or the early post-partum
period in fat beef (especially Hereford and Santa Gertrudis) and dairy breeds
(Holstein and Channel Island).
The chronic case which starts about the eighth or ninth month of gestation
presents quite different problems from the post-parturient form, and salvage
after parturition is the best solution, as it will recur in the succeeding gestation.
Predisposing factors
• excessive fat deposition in perivaginal connective tissue
• relaxation of sacrotuberous ligaments due to hormonal influence
(endocrine imbalance)
• increased intra-abdominal pressure following greater abdominal size in
late pregnancy
• high roughage intake
• severe cold weather and poor conformation (large flaccid vulva)
• severe post-partum tenesmus due to vaginal injury
• inheritance is postulated in some Hereford bloodlines, but not proven
Anus
Vulva
Figure 4.3 Pattern of Bühner suture in vulvar lips. The Gerlach-type needle,
threaded with umbilical tape, is inserted below ventral vulvar commissure, and is
passed through dense fibrous tissue to emerge above dorsal commissure. It is
unthreaded, and needle alone is passed up the other side in similar manner. It is
rethreaded, and tape pulled back ventrally. A quick release and adjustable knot is tied.
Suture material is only visible at the commissures.
Vulvar lumen should permit easy entry of four fingers. Only about 1 cm
length of tape is in contact with vulvar skin dorsally and ventrally. Sutures
may be completely buried by two 1 cm long horizontal incisions sutured in
mattress pattern, and placed dorsally and ventrally, if more than one month
prepartum. If inserted during late gestation, the suture is cut near the knot
and removed at term, therefore it is vital to watch carefully for first signs
of calving.
There is commonly vulvar oedema for several days. Local drainage of pus
frequently occurs. A sphincter-like band of connective tissue occasionally
results and may prevent future prolapse, but occasionally can cause dystocia,
necessitating dorsal episiotomy (see Section 4.4, pp. 154–155).
Technique 2 Transverse sutures:
An inferior modification of the above method involves nylon tape which is
inserted in two or three deep horizontal mattress sutures across the vulvar
lips. It can produce more severe local reaction, pain and irritation, leading
to continued tenesmus after analgesia wears off. There is inevitably an
increased risk of sutures tearing through skin.
148 Chapter 4
• insert needle with tape just lateral to the ‘hairline’ beside the vulvar
lips
• thread suture material through or simply tie the sutures over short length
of rubber or plastic tubing (‘quills’), reducing risk of suture tearout
Introduction
A radical method for preventing further vaginal prolapse, very effective
if properly performed in the valuable non-pregnant cow. Via a left-flank
laparotomy incision a suture is placed through ventral portion of cervix and
prepubic tendon just lateral to midline.
Technique
• select large full-curved cutting needle and thick, non-absorbable
multifilamentous suture material (polypropylene 7 metric)
• instruct assistant to apply uterine vulsellum forceps to ventral part of
cervical os per vagina, pushing forceps cranially to aid identification,
which is essential for correct placement, and for avoidance of urethra and
bladder
• after inserting ventral cervical suture pass double length of suture mater-
ial through prepubic tendon 5 cm cranial and lateral to pecten of pubis
(see Figure 4.4)
• throw knots outside abdominal cavity and carry them along suture
material with thumb and fingers to avoid entrapment of small intestine
• ensure minimum of four throws to each knot
• cut suture material with scissors, leaving 3 cm ends
Female urinogenital surgery 149
A B E
H
D
G C
This modified Winkler cervicopexy is easier and safer than the original
vaginal approach.
Introduction
Uterine prolapse occurs not infrequently (0.5% of calvings) following third
stage labour, and usually involves complete inversion of the gravid cornu.
Some cases follow an assisted second stage of labour. Almost unknown
following caesarean section. Nearly all cases occur within fifteen hours of
parturition.
Prevalent both in multiparous dairy cows in good condition (high protein
intake prepartum), and in cases of malnutrition and chronic disease. Some
cases predisposed by high oestrogen intake.
Aetiology unclear but uterine inversion and prolapse appear to be associ-
ated with onset of uterine atony during third stage labour. Many cows have
concurrent hypocalcaemia and clinical signs of milk fever.
150 Chapter 4
Treatment
Instruct farmer on phone or mobile to wrap prolapsed uterus in clean moist
sheet to prevent further contamination if cow is recumbent. If standing, and
sufficient help is available, uterus should be supported in slightly elevated
position in clean cloths until veterinary assistance arrives. The cow should be
kept quiet.
Figure 4.5 Optimal position for replacement of prolapsed uterus. Both hind legs are
extended caudally. Pelvis is tilted downwards about 30° in this position. In standing
cow a high epidural block may be given to facilitate manipulation.
Female urinogenital surgery 151
• with the organ elevated, so that its lower edge is level with the ischium,
start replacement by gentle pressure, using the palms of the obstetrically
lubricated hands (KY® jelly) over the areas nearest to the vulvar lips,
working in a circular manner around the mass
• practise gentle massage to avoid uterine perforation!
• after initial partial reposition, maintain reposed part by ensuring that the
remaining prolapsed uterus is kept above vulvar lips
• progressively replace whole organ in this manner and ensure that it
moves cranial to the cervix to its normal position
• if reposition is impossible after several minutes’ manipulation locate the
opening into the non-pregnant horn (usually about level with the vulva)
insert the closed fist and apply firm pressure into the pelvic cavity
• check there is no residual inversion of the cornu (e.g. use empty Ca bottle
as arm extension)
• if complete inversion is still impossible, fill uterine lumen with normal
saline, and then siphon off through disinfected stomach tube
• after reduction inject oxytocin (50–100 iu, i.m.) to speed involution
Limited vaginal trauma can be ignored, but a large deep laceration should be
sutured with catgut. Cows with extensive areas of vaginal epithelial necrosis
and trauma require submucosal resection which is a haemorrhagic, slow
procedure indicated only in selected cases.
Complications
Recurrence of the prolapse following return of sensation to the perineal
region is uncommon. The usefulness of a Bühner pattern vulvar suture (see
Section 4.2, pp. 146–147) inserted for two to three days to avoid this hazard,
is controversial. Follow-up visit advisable 12–24 hours later to check vagina
and cervix.
Other complications include haemorrhage, metritis, toxaemia, septicemia,
paresis, and uterine rupture with bladder or intestinal eventration.
Chronic cases present problems; through and through sutures of tape
or steel wire from vaginal lumen and lesser sciatic notch to skin, secured by
bandage or sponge have been attempted (Minchiv method).
Prognosis for rebreeding is good and recurrence of prolapse at next parturi-
tion is inexplicably uncommon.
Introduction
Major surgery with rare indications, amputation is performed in cows
in which the organ is so severely damaged (lacerations, necrosis, freezing,
gangrene) that reposition would result in death, and in cases of prolonged
prolapse in which replacement proves impossible. Amputation is sole
152 Chapter 4
Post-operative problems
Haemorrhage from uterine vessels, shock. Milking cows may remain pro-
fitable for one to two years as long as ovariectomy (see Section 4.5, p. 155) is
performed at hysterectomy.
Classification
• first degree: involves mucosa of vulva/vestibule/vagina
• second degree: involves full thickness of vulva/vestibule/vagina wall, but
not rectal wall or anus
• third degree: involves full depth of vulva/vestibule/vaginal walls, as well
as rectovaginal tears, including anal sphincter or rectovaginal fistula
This section considers primarily third degree perineal lacerations, i.e. the
most severe form.
Clinical signs
Injury is almost always a result of damage from fetal head or limbs at parturi-
tion. If possible injury can be anticipated, a veterinarian attending a dystocia
Female urinogenital surgery 153
Technique
• keep off feed for 12–24 hours
• caudal epidural analgesia in standing animal
• cleanse surrounding area and irrigate vagina with warm disinfectant
solution (povidone-iodine) and pack rectal lumen cranial to the defect
with absorbent cloths
• instruct assistant to retract the lateral borders of the cloaca to expose
cranially the shelf, formed by the rectal and vaginal mucosa dorsally and
laterally, and supporting the underlying muscular layers
• incise transversely along caudal edge of rectovaginal shelf, and extend
incision laterally to skin edge of original dorsal vulval commissure (see
Figure 4.6)
• completely separate the vaginal mucosa from the edge of this shelf to a
depth of about 5 cm
• suture the musculofibrous bridge, starting cranially, in a transverse plane
to appose left and right surfaces (e.g. 5 or 6 metric PGA)
• start suture in the vaginal lumen and also include the four edges of vaginal
mucosa
• ensure sutures are placed tight, and that their distance apart is such that it
is not possible to insert a digit between them
• avoid suturing skin edges caudally (contra-indicated) since it could
increase the difficulty in defaecation
• give systemic antibiotic prophylactic cover for 5 days
Problems
• inadequate mucosal undermining (a technically difficult procedure),
results in an inadequate thickness of bridge
• poor placement of sutures with excessive space, permitting faecal material
to pass into vagina
• sutures tearing out
154 Chapter 4
Figure 4.6 Repair of third degree perineal laceration with interrupted modified
Lembert suture in dorsal layer (rectum to dorsal vagina), and continuous horizontal
mattress suture in the vestibular mucosa. (From Youngquist, 1997.)
Episiotomy
Indication
When vulva and vestibule are liable to be torn at parturition due to fetal
oversize, small or immature vestibular region, or excessive friction resulting
from inadequate lubrication of area. Surgical incision is preferable to a
ragged, uncontrolled and bruised iatrogenic tear.
Technique
• make simple oblique incision through skin, and also vestibular mucosal
layer if necessary
Female urinogenital surgery 155
4.5 Ovariectomy
Indications
Alleged prolongation of lactation in mature cows as well as improvement in
feed efficiency compared with non-spayed heifers. Convenient husbandry
measure permitting spayed heifers and cows to run within herd with bull
without risk of pregnancy. Occasionally unilateral surgery in case of ovarian
pathology or persistent luteinised cyst.
Little comparative data is available regarding lactation and feed efficiency
in spayed and non-spayed cattle, and much of it is contradictory.
Not widely practised in Europe, but common in parts of both South, Middle
and North America, where a single surgeon, working at a restraint chute
with a well-organised team, can spay 40–60 heifers an hour. Operated
animals should be permanently identified.
Technique
The site for ovariectomy in a heifer (six to twelve months old) is the flank
(standing) or midline caudal abdomen (recumbent). In the cow it is the
vagina (colpotomy) or flank (standing).
Prior to surgery starve animal for 24 hours, no water restriction.
Flank approach
• clip left flank, wash, scrub and disinfect paralumbar fossa
• paravertebral analgesia (L1–2) or local infiltration (‘T-block’, ‘reverse 7’),
(see Section 1.8, pp. 26–27)
• practise aseptic technique: instruments and hands cleansed with quater-
nary ammonium disinfectant in repeated operations
• make vertical incision 10–13 cm long in left flank ventral to lumbar trans-
verse processes 3– 4
• separate muscles with scissors and incise peritoneum
• insert hand to enlarge peritoneal incision and locate ovaries
• remove ovaries with small effeminator (since ovarian pedicle is not
anaesthetised by paravertebral block, swab soaked with local anaesthetic
solution should be applied to pedicle for 1 minute before using effeminator).
Important: do not drop either ovary into abdominal cavity!
156 Chapter 4
C
D
F
E
3 cm
Figure 4.7 Ovariectomy with the Willis instrument inserted through vaginal stab
wound under rectal guidance. Ovary is manipulated through notch for transection of
ovarian pedicle. With K-R device inner sleeve cuts ovarian pedicle while retaining
ovary in lumen (see smaller illustrations).
A. sleeved arm in rectum; B. Willis instrument directed through vaginal fornix to ovary;
C. bladder; D. uterine body; E. Willis instrument and close-up; F. K-R instrument.
Female urinogenital surgery 157
Discussion
Untoward sequelae include excessive hemorrhage from the ovarian stump
especially from a granulosa cell tumour, and peritonitis.
In the USA specialized spay instruments (K-R: Jorgensen Laboratories,
Loveland, CO. and Willis: Willis Veterinary Supply, Prehso, SD) (see Figure 4.7)
have been developed for the colpotomy (vaginal) technique in pre-pubertal
heifers (see Further Reading, Appendix 1, p. 259).
The Willis technique (see Figure 4.7) involves bilateral intra-abdominal
ovariectomy via a stab incision in the vaginal fornix, using rectal palpation
firstly to locate the site of proposed penetration and secondly to manipulate
each ovary in turn through the sharp-edged lumen of the spay device. The
ovaries are left in the abdominal cavity. With the K-R (Kimberley-Rupp)
instrument, the ovary is retained in its lumen until the second ovary has been
removed. Various complications have been reported (haemorrhage, bowel
perforation, peritonitis).
Bovine Surgery and Lameness, Second Edition
A. David Weaver, Guy St. Jean, Adrian Steiner
Copyright © 2005 David Weaver, Adrian Steiner and Guy St Jean
CHAPTER 5
Teat surgery
5.1 Introduction
Intensification of dairy farming has led to earlier culling of cows with many of
the teat problems discussed in this chapter (‘hard milker’, see Section 5.2, teat
lacerations, see Section 5.5), which fail to respond to simple management
such as a topical spray. In many countries treatment may be uneconomic.
But in the developing world with small herds the individual cow remains a
valuable resource and the owner demands maximum care and attention to
teat conditions.
Significant teat injuries commonly affect the orifice, and less commonly
the teat sinus wall. Teat surgery is a demanding test of the skill of the
veterinarian.
Restraint and anaesthesia (see Chapter 1): xylaxine alone is very effective
for minor procedures, but it is contra-indicated in advanced gestation.
Beware possible recumbency! Wopa crate with one leg lifted is ideal restraint
method. Local anaesthesia at the teat base, with or without sedation, and
with the cow restrained in lateral recumbency, is another option.
Economic loss results from a loss in milk yield (take care with antibiotic-
treated milk; possible loss of quarter if there is a necessity to dry off ).
Anatomy
• teat orifice or ostium papillare
• streak canal or ductus papillaris
• Furstenberg’s rosette
• teat sinus, pars papillaris or lactiferous sinus (teat part)
• lactiferous sinus (glandular part), milk cistern or pars glandularis
• teat canal: longitudinally folded stratified squamous epithelium
Teat surgery 159
5
C
6
D
4
B
3
A
2
1
B
3
A 2
1
Aetiology
Common problem. Partial obstruction (‘hard milker’) due to local trauma,
possibly secondary to milking machine malfunction (e.g. excessive vacuum
Teat surgery 161
Signs
Quarter milks out slowly, or ‘valve’ is evident, and vicious cycle may develop
as remaining quarters tend to be overmilked, resulting in bruising and ever-
sion of teat orifice and development of mastitis. Some cases are inoperable.
Treatment
Controversial, and there are no controlled studies on efficacy of method.
Non-infected case (i.e. no mastitis) and non-inflammatory teat orifice
lesion:
Figure 5.3 Theloresectoscopy. Scope is introduced into teat sinus through lateral
teat wall incision. Stenotic tissue around Furstenberg’s rosette is removed with the
cautery sling.
Signs
Often asymptomatic but can eventually cause interference with free passage
of milk, is rarely pedunculated, but painless.
Treatment
Complete removal is often difficult, and recurrence rate is high!
• teat lance or Hug’s knife (see Figure 5.2b) is inserted in attempt to break
down the annular membrane
Prognosis is very poor and treatment usually hopeless.
Introduction
Factors affecting outcome and prognosis include:
Treatment
Superficial wounds: basic surgical principles apply and all wounds must
be regarded as contaminated.
Local antibiotics: apply only to skin suture line, never to wound surfaces,
where they delay healing. Use penicillin + streptomycin (Streptopen®
Schering-Plough) or oxytetracycline hydrochloride (Terramycin® Pfizer) in
powder, cream or aerosol preparations.
Use of routine intramammary antibiotic is controversial.
Passive milk drainage for ten days before resuming machine milking
Problems include excessive suture tension, which causes puckering and
skin necrosis, and poor healing resulting from inadequate débridement or
cleansing of lesion.
Introduction
Fistulae are usually acquired. Treat recent (< 12 hours) fistulae by immediate
surgery (primary wound healing). Repair older wounds by tertiary wound
healing, (e.g. 10–14 days post-trauma or during dry period). Prognosis is
guarded.
Work in good operating facilities, with adequate light, cleanliness and
efficient analgesia. Ensure stockman understands post-operative care.
Surgical technique
• cleanse with non-irritating antiseptic
• trim off devitalised skin, muscularis and mucosa
• appose or invert mucosal edges, but suture submucosa and muscularis
with interrupted sutures of 3 metric PDS on swaged-on needle. Do not
suture mucosa!
• suture skin with simple non-absorbable (e.g. polyamide 2 metric) inter-
rupted mattress sutures to produce precise apposition of edges
• use of protective bandage and self-retaining impregnated cannula for sev-
eral days is controversial, and lacks comparative studies (e.g. ‘Opsite’®)
• perform passive milk drainage every one to two days (depending on
quarter yield), and insert intramammary preparation every second day
• healing takes about ten days, when sutures are removed. Cases of wound
breakdown should be re-operated at the earliest possible moment in the
dry period.
Causes of breakdown
• severe post-operative oedema
• poor suture technique
• excessive suture tension
• necrosis of wound edges
• infection
Local non-surgical treatment with organic acid, butter of antimony and,
most recently acrylics and electrocautery, usually fails to close a teat fistula.
Teat surgery 165
Treatment
• difficult and indicated only in chronic case (> 3 weeks) as fibrosis of granu-
lation tissue repair may correct condition spontaneously
• inject minute volume of irritant drug (e.g. sterile Lugol’s iodine) with
tuberculin syringe around teat orifice (e.g. 4 × 0.1 ml) to stimulate discrete
circumferential fibrosis
Technique is hazardous and results unpredictable.
Supernumerary teats
Introduction
Congenital and inherited condition. The teats tend to be small, are commonly
caudal, but sometimes are attached to the normal teat. Remove when one to
nine months old, and never within one month of parturition (oedema, wound
breakdown, infection, mastitis). Up to three months old, removal may be
performed by unqualified but trained person, but under anaesthesia. UK
law requires that surgery in calves over three months old be performed
by veterinary surgeon under anaesthesia. Swiss law requires all ruminant
surgical procedures to be performed by veterinarian under anaesthesia.
Many countries have no legislation to cover this, and many other specific
procedures.
Technique
• carefully identify supernumerary teats
• small calves: resect with scissors
• in older calf crush at base with small Burdizzo® (Emasculatome) and resect
with knife along inner edge of blades
• line of section should be cranial to caudal, not transverse, so that sub-
sequent scar merges into natural folds of udder skin
• suture only if wound edges separate
166 Chapter 5
Technique
• analgesia of teat base and application of good restraint
• place Burdizzo® at junction of middle and distal thirds of teat, amputate
with scalpel distal to jaws
• retain teat lumen by continuous sutures in wall (skin to mucosa) using
interlocking mattress suture to maintain drainage
Haemorrhage is usually slight.
Quarter will eventually dry off as a result of secondary infection and mastitis.
Introduction
Teat amputation may also be indicated in cows with severe teat damage
where reconstructive surgery and return to normal function cannot be
expected, e.g. loss of distal portion of teat, or long, oblique or transverse tears
into teat canal. Amputation and closure of teat sinus is only successful in the
absence of infection.
Technique
• amputation site is 1–2 cm distal to udder-teat junction
• transect teat by scalpel, resecting the mucous membrane 1 cm below the
cut surface
• invert mucosa by continuous suture in submucosa (see Figure 5.4)
• insert horizontal mattress sutures to close musculature and appose skin
edges with simple sutures or metal clips (Michel)
• infuse antibiotics into the quarter before final sutures are placed.
In gangrenous mastitis, following teat amputation at the junction with
udder, a cruciate incision is made into udder skin to permit optimal drainage
and exposure to atmosphere to inhibit anaerobes. Irrigation with dilute H2O2
is useful.
5.9 Discussion
Meticulous care to details of technique is vital in surgical repair of severe
traumatic teat lesions. A multiplicity of suture patterns illustrates the unsat-
isfactory results obtained in certain hands, but this is more likely to be a result
of deficiencies and breakdowns in basic surgical principles, than to any defect
in the suture configuration itself.
Teat surgery 167
Figure 5.4 Teat amputation with primary closure: cut surfaces for closed teat
amputation.
CHAPTER 6
Introduction
A mild degree of intermittent preputial prolapse or eversion is considered
normal in some breeds, notably the polled Hereford and Aberdeen Angus in
the UK, together with the Brahman and Santa Gertrudis breeds (Bos indicus)
in North America.
Prolapse develops during normal non-erectile movement of the penis
within the preputial cavity. Pathological prolapse is more likely in individuals
exposed to trauma.
Predisposing factors
• pendulous and long sheath
• large preputial orifice with limited ability to contract
• poor development of the preputial and retractor penis muscles in some
polled breeds (see above)
Preputial trauma
Pathological prolapse is more likely in individuals at range or pasture exposed
to trauma, which may involve irritation from foreign bodies such as vegeta-
tion, dust or earth, and which are secondary to penile injury.
Common site of injury is the mucosa adjacent to skin-prepuce junction.
Frostbite can cause major problems in certain areas in the winter. All cases
of preputial prolapse should have complete physical examination of the
external genitalia.
Sequence of events following injury is:
• as a result, penile erection may be abnormal, with only the glans tip
passing through this damaged region
Another common site of preputial trauma leading to prolapse, is the
reflection of parietal prepuce on to the body of the penis. It may be sustained
during natural or artificial service.
Conservative treatment
Recent injury to prolapsed mucosa may be treated conservatively:
• do not remove the preputial sutures because such attempts may damage
the surgical wound
• keep the bull from breeding for at least 60 days when, if possible, the
animal should be evaluated to make sure the penis is extendable with-
out restriction of the prepuce. Oedema of the prepuce usually persists for
ten days after surgery. NSAIDs and diuretic agents can be used if oedema
is excessive
Intra-preputial adhesions
Introduction
Intra-preputial adhesions present problems in exposure, evaluation and
management. Exposure may be very difficult and accompanied by tearing of
the adjacent preputial mucosa.
Degree of mechanical hindrance caused by the adhesions may be hard to
evaluate since, though some adhesions will be palpable, others will not.
Adhesions are frequently obliquely longitudinal rather than circumferential.
Surgery
• remove mucosa overlying the adhesions between circumferential
incisions
• resect all fibrotic adhesions down to the tunica albuginea (TA)
• carefully appose mucosal edges, as in the first technique (see p. 170)
Bull should be rested for two to three weeks, depending on degree of
post-operative oedema, and can then be teased with increasing frequency
(initially every three days, later daily) to prevent recurrence of fibrosis and
adhesions.
Prognosis is guarded or poor depending on area resected.
Introduction
Condition is more accurately termed rupture of the corpus cavernosum penis
(CCP) with a rent in the tunica albuginea (see Figure 6.1), through which blood
explodes into the surrounding tissues.
Vigorous, over-enthusiastic thrusting at intromission, or possibly spontan-
eously during masturbation. Penis may undergo severe downward bending
leading to tear in tunica albuginea (TA). Alleged higher incidence in horned
English breeds (e.g. Hereford).
Male urinogenital surgery 173
1
7
5
Figure 6.1 Cross-section of penis just distal to distal flexure (sigmoid) to show
haematoma site.
1. deep veins of penis; 2. artery of penis; 3. tunica albuginea; 4. corpus cavernosum
penis; 5. corpus cavernosum urethrae; 6. usual site of penile haematoma, with blood
from corpus cavernosum penis escaping through dorsal tear in tunica albuginea;
7. urethra.
Pathology
Site is immediately prescrotal and usually dorsal, close to insertion of the
retractor penis muscles near the distal flexure of the sigmoid. Rupture of CCP
causes immediate haematoma which may grow over a few days to a variable
extent as a result of slow leakage. Lesion may be strictly localised or relatively
diffuse. Secondary preputial oedema and preputial prolapse may occur,
rarely with some penile protrusion. Compression of lymphatic and venous
drainage may cause secondary preputial prolapse.
The natural course of penile haematoma is a gradual reduction of the
swelling, as oedema disappears and the haematoma is slowly organised into
fibrous tissue. A significant proportion of cases of penile haematoma however
develop a serious complication – an abscess at the site (often Arcanobacterium
pyogenes) and a fibrous adhesion – and the prognosis is then grave.
Abscessation usually leads to a fluctuating swelling to one side of penis,
separate from penile body. Avoid exploratory paracentesis, which can result
in iatrogenic infection of a sterile haematoma.
Differential diagnosis
• preputial prolapse of primary origin
• penile injury of other aetiology
• urethral rupture due to occlusion by calculus
174 Chapter 6
Conservative treatment
Small haematoma rapidly reduces in size, is often hard to detect ten days
later, and requires no treatment.
A larger haematoma may resolve following medical treatment:
• remove bull from herd and ensure sexual rest for 60 days
• give systemic antibiotics for seven days
• apply hot packs, cold water sprays, or possibly ultrasound; all these
methods lack controlled studies but have allegedly reduced the healing
period, but also increase the degree of fibrosis
• after 30 days manually extend penis and check sensation of free portion.
Lack of sensation indicates bilateral nerve damage and bull will neither
breed nor ejaculate into artificial vagina
Surgery
Due to the possibility of infection entering the haematoma and causing
abscessation, surgery is often advisable for all cases, except smaller
haematomata (< 20 cm) that rapidly resolve.
Complications
Temporary seroma formation, abscessation, adhesions to sheath, nerve
damage, (with desensitisation of glans penis) vascular shunt formation,
recurrence of injury, and preputial injury from secondary prolapse.
6.3 Urolithiasis
Introduction
Calculus is a clinical problem in entire but more frequently in castrated male
cattle. Triple phosphate calculi are found in cattle on concentrate feed; and
silica calculi (e.g. North America) in cattle on high silica pasture grass or hay.
Urolithiasis is not a problem in female cattle due to their relatively larger
urethral diameter, though severe cystitis occasionally results from a bladder
packed with calculi.
Clinical signs
• lodgement at proximal or distal part of sigmoid flexure, distal 30 cm of
penis, or over ischial arch
• initial straining with partial or complete urinary obstruction
• clinical cases are dull and feed intake is reduced, and after the initial
24 hours of obstruction straining ceases
• pressure necrosis of urethral mucosa and eventual urethral rupture with
seepage of urine into subcutaneous tissues of the ventral body wall and
possibly scrotum is possible
• rupture of bladder, often in dorsal cranial part of fundus but occasionally
near bladder neck, and gradual accumulation of intra-abdominal urine is
another possibility (‘water belly’)
• subcutaneous accumulation of urine, which should be treated by inci-
sional drainage, eventually results in skin slough as blood supply is
impaired, leaving moist area of granulating tissue (30– 40 cm diameter)
in which the penis may be identified and from which urine drips (mild
uraemia)
• following complete urinary obstruction, and bladder rupture, cattle
remain comparatively bright; blood urea increases after three days at a
rate of about 10 mmol/litre/day, with death from uraemia and associated
metabolic problems after seven to ten days.
176 Chapter 6
Treatment
Emergency surgery may be undertaken in uraemic cattle, with the aim of
economic salvage several weeks later when there is no metabolic abnormal-
ity and the surgical wounds have healed. In rare cases an attempt is made to
preserve the breeding capacity of a valuable bull by urethrotomy, but surgery
is seldom successful for several reasons:
Ruptured bladder
Diagnosis is based on:
Treatment
As a first step abdominal urine is drained slowly (approximately 2 litres/
5 minutes) via ventral abdominal cannula attached externally to wide-bore
tubing and screw clips (to adjust flow rate). This drainage may start before
preparation for laparotomy. Rapid reduction of intra-abdominal pressure
imposes unnecessary cardiovascular stress as abdominal venous bed dilates.
If general condition permits, left flank laparotomy is done standing, other-
wise in right lateral recumbency.
• grasp bladder with right hand and explore surface with left hand – rupture
is frequently found dorsal and cranial. Rupture more caudally, involving
bladder neck and trigone area, is extremely difficult to repair surgically
• evert bladder and examine mucosa especially of neck, to assess severity of
cystitis and to remove any calculi
• calculi detected in peritoneal cavity are harmless
• confirm patency of distal urinary tract (i.e. urethra) by flushing saline via
catheter inserted through bladder neck, around ischial arch; in case of
urethral obstruction further surgery is indicated (see above and below)
• place continuous inversion suture (Lembert or Cushing pattern) in
bladder wall using 7 metric chromic catgut
• close body wall routinely (see Section 3.3, Closure of flanklaparotomy
Incision p. 86), disregarding residual abdominal urine
• ensure good flank wound apposition, removing blood and urine from
flank musculature
Alternative technique for salvaging steer or bull with dorsal and cranial
bladder rupture relies on spontaneous healing of this wound (see Figure 6.2).
Figure 6.2 Implantation of Foley catheter into urinary bladder for temporary
drainage in urolithiasis in male cattle. Catheter exits the abdominal cavity to the right
of the prepuce.
178 Chapter 6
Urethrostomy
Technique
• caudal epidural analgesia
• routine skin preparation from anus to scrotal neck and about 10 cm to
each side of midline
• midline skin incision from dorsal aspect of ischium distally for 15–20 cm
• blunt dissection around distal part of root and proximal body of penis; the
crura are surrounded by the ischiocavernosus muscles which meet in a
midline raphé (see Figure 6.3)
• incise penis longitudinally, precisely in midline (otherwise urethra
will be bypassed), separating bulbo-urethral and ischiocavernosus
muscles
Male urinogenital surgery 179
2
9
1
10
3
5
4
6
7 11
Figure 6.3 Horizontal section through perineal region of steer to indicate structures
in perineal urethro(s)tomy.
1. corpus cavernosum; 2. tunica albuginea; 3. urethra; 4. corpus spongiosum;
5. tunica albuginea of corpus spongiosum; 6. perineal fascia; 7. retractor penis
muscle; 8. dorsal artery, vein and nerve of penis; 9. deep artery of penis; 10. medial
muscles of thigh; 11. skin.
Penile amputation
Involves creation of a permanent perineal urethrostomy from the prox-
imal part of the transected penis. The distal penis is resected. It is a salvage
operation.
Technique
• caudal epidural analgesia, and prepare skin as for previous technique
• skin incision 15–30 cm long, midway between caudal aspect of scrotal
neck and ischium
• isolate penis from surrounding structures, pulling penis forcibly through
skin incision
• identify the fine pink retractor penis muscles, and clamp proximally with
artery forceps before sectioning distally
• continue upward direction of traction on the penis and dissect bluntly,
with fingers around the sigmoid flexure to facilitate easy exteriorisation of
this portion; penis still remains attached to prepuce
• either continue traction to tear down the preputial attachment to skin
at the preputial orifice, or incise the preputial tissues with scalpel and
scissors just caudal to skin-preputial junction; leave preputial orifice
unsutured
• transect completely exteriorised penis after ligation at a point estimated to
permit about 10 cm protrusion of the penile stump through the skin
wound
• ligate dorsal artery and vein of penis, situated cranially in stump, with
7 metric chromic catgut
• incise urethra proximally from cut end for 3 cm to produce a flared spatu-
late end to hinder stenosis
• place PGA sutures through each side from external fibrous coat into
urethral mucosa for haemostasis
• suture penis into skin edges so that stump protrudes about 5 cm at angle of
30° to horizontal
• appose remaining subcutaneous tissues and skin by monofilament nylon
sutures
• give systemic antibiotics for five days. Clean the penile stump twice
daily for three days.
Further haemorrhage occasionally requires additional ligation.
Discussion
Ventral abdominal subcutaneous accumulation of urine resulting from
urethral rupture can be drained via multiple stab incisions.
Complications include slow continuing haemorrhage and development of
stenosis. In some cases a misdirected flow of urine causes soiling of the skin
of the hind legs.
Male urinogenital surgery 181
Introduction
Various methods have been developed to prevent intromission (insertion of
the penis into the vulva and vagina of the female) in cattle. One method,
penile translocation, is outlined as a possible surgical technique (see below).
Several techniques may be unlawful in some countries, and unethical in
others.
Other surgical techniques to prevent intromission include:
Penile-prepuce translocation
Introduction
Translocation (or transposition) of the penis is used in production of teaser
bulls. Operation is combined with vasectomy or epididymectomy to render
the animal sterile. Translocation avoids the hazards of possible spread of
venereal disease by preventing intromission. It is claimed that libido is main-
tained. Surgery should be done well before the breeding season in animals
ideally 250–300 kg. Operation creates a new preputial opening into which
the penis and prepuce are sutured. Surgery is performed in dorsal recum-
bency under GA or deep sedation with local analgesia.
This form of surgery on normal cattle has been forbidden in the UK under
the Welfare of Livestock (Prohibited Operation Regulations) Act 1982.
Technique
• the aim being to redirect the penis 30° laterally, usually to the right, mark
the proposed site on the skin in the standing bull. The place is usually
at the level of the fold of the flank (see Figure 6.4)
• following anaesthesia and turning bull into dorsal recumbency, clip and
disinfect the new site and the preputial region for an aseptic procedure
• irrigate preputial cavity with a dilute (1%) povidone-iodine solution and
close orifice with purse-string suture (infection risk!)
182 Chapter 6
C
F
C
Figure 6.4 Penile and preputial translocation in young bull (‘teaser bull’), ventral
view, lines of skin incisions around prepuce, penis and new body wall site are shown
as interrupted lines ( ).
A. umbilicus; B. skin-prepuce junction in midline; C. penis; D. scrotum; E. level of
sigmoid flexure; F. fold of right flank.
• remove 8 cm diameter circle of skin from the new site and cover tempor-
arily with a moist sterile swab
• make corresponding incision around preputial orifice, having marked
(e.g. with temporary suture) cranial midline point, and continue dissec-
tion close to midline caudally
• elevate the preputial coat from the body wall and ligate the extensive
vascular supply
• stop dissection at distal part of the sigmoid flexure; this tunnel may be
advantageously started with long-handled straight scissors
• cover prepuce with sterile glove before pushing it into subcutis
Male urinogenital surgery 183
• carefully avoiding any torsion on the penis or prepuce and noting cranial
midline point previously marked, place preputial skin in new site and
move penis into appropriate position along abdominal wall (see Figure 6.4)
• insert a series of interrupted chromic catgut sutures in the subcutaneous
tissues
• suture skin with simple interrupted sutures of monofilament nylon
• close midline skin defect similarly, but include several deeper sutures into
linea alba and rectus sheath to avoid creation of potential dead space
• five-day course of systemic antibiotics
• perform epididymectomy (see Section 6.6, pp. 185–186) or vasectomy
(see below).
Three weeks after surgery several ejaculates (approximately three) should be
evaluated to ensure that bull is safe for use as ‘teaser’.
6.5 Vasectomy
Introduction
A portion of ductus deferens is removed from the spermatic cord on the
cranial aspect of the scrotal neck (see Figure 6.5). This technique is practised
2 4
1
8 7
5
3
Anaesthesia
Standing method: xylazine sedation (low dose range, i.e. 0.1– 0.15 mg/
kg i.m.) followed by local infiltration with 10 ml 2% lignocaine injected
subcutaneously around proposed incision site, carefully avoiding possible
injection into pampiniform plexus.
Recumbent method: xylazine sedation (high dose range, i.e. 0.2 mg/kg
i.m.) supplemented by local infiltration.
Surgical technique
• clip hair from entire upper half of the scrotum and scrotal neck
• scrub and thoroughly prepare scrotum and adjacent skin for aseptic
surgery
• apply povidone-iodine twice to the scrotal skin
• make vertical incision 5 cm long on caudolateral (if standing) or
craniomedial (cast) aspect of lower part of scrotal neck over tensed cord
structures. In standing position the skin must be rotated through 90°
• grasp spermatic cord between thumb and first two fingers and gently
rotate to identify ductus deferens as very firm thick string or wire-
like structure about 4 mm diameter (it is the hardest structure in the
cord)
• carefully make small nick in vaginal tunic over the ductus deferens and
place hook beneath it, or grasp in Allis tissue forceps
• bring ductus through skin incision and clamp across with two pairs of
artery forceps about 5 cm apart (see Figure 6.6)
• resect intervening section of ductus with scissors and place silk ligatures
(3 metric) below each forceps
• release forceps; ligature avoids possible recanalisation
• retain ductus for identification (e.g. examine for semen) and possible
histopathology, as potentially useful evidence in eventual litigation
• close skin incision with interrupted horizontal mattress sutures of
monofilament nylon
• repeat surgery through second incision on other side
• give systemic antibiotics for five days
• check bull for absence of semen by teasing once weekly for three weeks
• remove skin sutures after 10–14 days
Male urinogenital surgery 185
E
D
Figure 6.6 Vasectomy in recumbent bull. Vertical incision in lower scrotal neck and
cord structures elevated by scissors (see also Figure 6.5).
A. cord-like ductus (vas) deferens in internal tunica vaginalis, held by Allis forceps;
B. non-absorbable sutures ligating ductus before resection of 5 cm; C. adjacent
pampiniform plexus; D. cremaster muscle; E. fold of external tunica vaginalis incised
to expose A. and C.
6.6 Epididymectomy
Introduction
The tail of the epididymis is resected. Resected tissue must be checked for
semen, since, inadvertently, only fat and connective tissue may be removed.
Surgery can be done in standing bull under xylazine sedation and local
infiltration. Strict asepsis is essential.
186 Chapter 6
Figure 6.7 Location of head, body and tail of epididymis in relation to testicle. Arrow
indicates direction and site of incision in an epididymectomy.
Technique
• clip, wash and disinfect entire scrotal surface; dry and repeat disinfection
• push testicle distally with one hand so that epididymal tail is readily
identifiable
• incise into epididymis at most ventral point, avoiding testicular substance
(see Figure 6.7)
• grasp large portion of tail with Allis forceps and place large artery forceps
transversely proximal to this tissue, which is then resected
• place firm suture of PGA (7 metric) proximal to the artery forceps which is
then removed
• insert two to three horizontal mattress sutures to appose skin edges
• give systemic antibiotics for five days
• remove sutures in 10–14 days
• tease bull weekly for three weeks when no live sperm should be seen; bull is
then suitable for work
Discussion
Again portions of epididymis removed at surgery should be retained as a
precautionary measure should litigation materialise, based on a claim that a
bull has remained fertile. Recanalisation is impossible following the above
techniques, in which the lumen of the ductus and epididymis are occluded by
encircling ligatures.
Sclerosing agents have also been injected into the testicle and epididymis of
bulls to produce fibrosis and to abolish spermatogenesis and sperm transport.
They are less reliable than surgical methods.
Male urinogenital surgery 187
Introduction
This congenital defect, involving the apical ligament, occurs in bulls older
than one year. Many affected bulls are known to have served successfully,
and have sired progeny. Any breed can be affected, but polled breeds such as
polled Hereford have a higher incidence. Inheritance is questionable.
Signs
• seen just before or immediately following extrusion of the penis from the
sheath
• in severe cases the penile tip is caught in distal part of preputial cavity and
may only be extruded naturally with some difficulty
• extruded penis spirals to left or right through 30° angle, viewed from the
right side, and 180–270° when viewed (theoretically) from the rear
• glans penis tends to hit right perineal region of cow, about 20–30 cm from
the vulva
Spiralling action may be variable in degree; in intermittent cases bulls
may maintain a low level of fertility in the field. In normal bulls, occurrence
of deviation and complete spiralling after intromission increases the
contact area between the penis and vagina, and may therefore increase
tactile stimuli and so promote ejaculation. In affected bulls the deviation
or complete spiralling occurs prior to intromission and prevents coitus.
Anatomical explanation involves slipping of the dorsal apical ligament across
to the left and ventrally. The penile integument in affected bulls is then
fully stretched over the penis and produces spiralling early in the process of
copulation.
As long as the inheritance remains questionable, surgery should only be
undertaken after consideration of the ethical position, and then reserved for
valuable bulls required for natural service.
Surgical techniques
Two techniques are given, one using penile tunica albuginea (TA) the other
with fascia lata from the thigh region.
Technique 1 Penile tunica albuginea (see Figure 6.8):
3
1 2
2 1
3
B C
• make dorsal midline incision through penile mucosa from just cranial to
reflection of prepuce forwards to just caudal to glans
• expose underlying dorsal ligament of penis
• incise longitudinally through middle of ligament into TA
• incise 3 mm laterally to left and right, parallel to previous incisions
• incise transversely and distally across distal end of previous three incisions
so creating two strips (2 mm wide) of ligament and TA
• resect about 1 cm of strip length and re-attach strips to distal end of dorsal
ligament with alternate sutures of 6 metric chromic catgut and 3 metric
stainless steel (respectively to provoke a tissue reaction and for strength)
Male urinogenital surgery 189
• general anaesthesia
• fix the bull in right lateral recumbency
First collect the fascia lata graft as follows:
• clip and prepare a liberal area from the proximal tibia to the tuber coxae for
surgery
• make an incision beginning 8 cm dorsolateral to the patella and continued
for 20 cm toward the tuber coxae, continue the incision to the fascia lata of
the vastus lateralis muscle
• collect a 3 cm wide and 20 cm long rectangular strip of the deep fascia
lata. Remove connective tissue from the strip, and keep graft in saline;
(homogenic fascia lata preserved in 70% ethyl alcohol also has been used
successfully to reduce surgical time and avoid a second incision on the
patient)
• close fascial layers in a simple continuous pattern and appose skin with
non-absorbable suture material in routine fashion
• extend the penis manually, and prepare the penis and prepuce for aseptic
surgery
• make a 20 cm skin incision on the dorsum of the penis starting about
2.5 cm proximal to the tip
• deepen the incision to the white fibrous apical ligament
• reflect the apical ligament laterally in both directions, exposing the TA
• do not incise the two veins on the right ventral aspect between the
ligament and the TA
• place the fascia lata graft between the apical ligament and the TA on the
dorsum of the penis
• insert four interrupted sutures of 2 metric polyglactin 910 through the
fascia lata and into the TA under the ligament, near its origin
• then place interrupted sutures along the lateral margin of the graft at
2.5 cm intervals to stretch the implant
190 Chapter 6
• trim the implant to fit the distal end of the penis and suture under tension
in an interrupted pattern
• return the apical ligament over the implant and suture it with a simple
interrupted pattern of the same material; the thickest portion of the
ligament should be on the dorsum of the penis
• close the last layer with 3 metric polyglactin 910
• insert a tube into the preputial cavity and secure to the sheath with elastic
tape to maintain the penis in a retracted position
• give systemic antibiotic agents for three to five days
• maintain sexual rest for 60 days
In some cases (resulting from over- or under-correction) a second operation is
required. The prognosis remains guarded.
Persistent frenulum
Introduction
Congenital anomaly. Persistence of embryonic ectodermal lamella connects
penis to the penile part of prepuce, which usually splits after the calf is two
months old, and in which completion is hormone-dependent, but may be
delayed until eight months. Excessive thickness of ventral bridge (= frenulum),
perhaps containing blood vessels, may be an aetiological factor.
Signs
Band of fibrous tissue runs from close to penile tip to near junction of penile
part of prepuce and sheath, causing marked ventral deviation of erect penis.
This prevents intromission.
In the USA it is most common in Aberdeen Angus and Shorthorn bulls, but
has low incidence.
Treatment
• ligate blood vessels in frenulum and section fibrous structure with scissors
Good prognosis. Condition possibly inherited, therefore ethics of surgery are
dubious.
Papillomatosis
Occurs in young bulls, reared in groups. Aetiologically a host-specific
Papovavirus, (BPV1).
Signs
• haemorrhage from penis, often on turning out to cows or at breeding
examination
• located on free portion of penis; generally multiple and sessile, but chronic
cases may have pedunculated mass
• phimosis or paraphimosis is possible
Treatment
• slow spontaneous regression can occur
• autogenous wart vaccine usually unsuccessful
• surgical removal (knife or Burdizzo®), electrocautery or cryosurgery
• unless simple procedure, patient should be in lateral recumbency to
facilitate precision
• sedation with xylazine
• analgesia by local infiltration of dorsal nerves of penis (see Section 1.8,
p. 31) or subcutaneous ring block
• care required not to open urethra (potential fistula formation)
• ligate or cauterise significant bleeding vessels
• close epithelial defect with 0 metric chromic catgut (not essential)
The prognosis is good.
6.9 Castration
Introduction
Need for castration has been increasingly questioned on scientific, economic
and humanitarian grounds. Two forms of castration are available: bloodless
and open surgical (scalpel).
192 Chapter 6
Bloodless methods
Analgesia
In the UK, legislation (Animal Anaesthetics Act 1964) makes it obligatory
that castration of calves over two months old be performed under anaesthesia
or analgesia.
In Switzerland castration without anaesthesia is forbidden.
Burdizzo® method
The Burdizzo® instrument is 30 or 40 cm long, and has cord stops. It
is used on calves one to twelve weeks old, depending on breed and
development.
Male urinogenital surgery 193
Figure 6.9 Diagram of vertical section through scrotum, showing correct position for
application of Burdizzo® (bloodless) emasculator. Cord is pushed laterally to produce
minimal skin trauma. Area of undamaged skin is left in midline and maintains blood
supply to ventral part of scrotal skin. The instrument is applied remote from penis.
1. testicle; 2. spermatic cord; 3. penis.
• surgeon stands beside the calf, keeping the hindquarters against a suitable
pen wall with the head placed and tied or held in a corner by assistant
• surgeon controls the correct application of the Burdizzo® (see Figure 6.5):
the instrument is applied laterally onto the scrotal neck by assistant
behind calf
• cord is held laterally in scrotal neck by first finger and thumb of surgeon
• the second hand controls position of the jaws; instruct assistant initially to
close the jaws slowly until they are about 8–10 mm apart and are about to
clamp skin and cord firmly
• with cord precisely located between the jaws, order rapid closure
• maintain closed for 5–10 seconds, during which operator checks that
cord is correctly crushed
• characteristic crushing sound accompanies the closure. Cord-stops on
the emasculator blades help to prevent displacement of the cord during
closure
• separate jaws 1 cm, slide them 1 cm distally, and close a second time on
the same side. In contrast to the first crushing, there is minimal pain
reaction
• repeat the procedure on the second side
• ensure that the crushed lines in the skin are offset (see Figure 6.9) and
do not form a continuous band around the scrotal neck which could
otherwise lead to skin necrosis with infection. Do not crush the median
(scrotal) raphé.
Another Burdizzo® model has a knee grip. In this technique the assistant
restrains the hindquarters, while the surgeon holds the cord in position with
194 Chapter 6
one hand while closing the instrument by moving one handle against the
knee-fixed second handle. A certain dexterity is required.
The effect after four weeks (young calf) or six weeks (older calf) is atrophy
of the testicular tissue, which forms a fibrous knob or knot-like structure
approximately the diameter of the spermatic cord.
Complications
Problems are infrequent but can include:
Technique
• perform surgery in standing position with stockman restraining head and
hindquarters and holding tail laterally
• induce local analgesia, as described above
• wash and cleanse scrotal skin with dilute (0.5%) povidone-iodine solu-
tion, and preferably wear disposable gloves
• stand or crouch behind calf to make vertical incision through caudal
scrotal skin into testicular substance, holding testicle tensed and pulled
distally, and continue incision along distal, i.e. ventral border of scrotum
(ensuring subsequent drainage)
• scrotal incision should be slightly shorter than testicular length.
Initial scrotal incision may be made with Newberry® knife (Newberry®
castrating knife, Jorgensen Labs, Loveland, CO. USA), a 24.5 cm long
instrument with steel-bladed clamp) which is placed transversely across
Male urinogenital surgery 195
Figure 6.10 Newberry castration technique. View from rear, showing testes pushed
upwards, scrotum pulled down by hand, and Newberry knife being applied across
scrotum for transverse incision, before being pulled quickly downwards. Dotted lines
represent the position of the tunica vaginalis, through which the testes are then extracted.
the base of the scrotum, closed, and immediately pulled ventrally to open
both scrotal sacs without removal of any scrotal tissue (see Figure 6.10).
Both testicles may then removed with the emasculator.
• testicle prolapses through skin wound, is grasped, and vascular and non-
vascular portions of the cord are identified (vascular: cranial including
pampiniform plexus and vas deferens)
• insert first finger through tunica vaginalis proximal to the epididymis, and
between vascular and non-vascular parts.
Technique now varies depending on method of haemostasis:
• small calf (one week to two months): emasculator, torsion, traction are
possibilities in descending order of preference
• large calf (two to six months): emasculator, torsion. Traction is contra-
indicated as excessively painful
• small bull: emasculator, possibly with ligation
All other methods carry a risk of severe haemorrhage.
196 Chapter 6
Emasculator method
• apply after separating vascular and non-vascular parts of cord
• brief period (10 seconds) to crush non-vascular position just proximal to
epididymis
• longer period (20–120 seconds depending on size of cord and the age of
the animal), crushing proximal part of vascular portion of cord, using
traction on distal structures to separate them from jaws of instrument
Torsion method
• break down non-vascular part of cord by traction
• twist vascular portion several (five to six) times in proximal part of cord,
then use gentle traction to break cord distal to torsion point
Traction method
• break down non-vascular part, then grasp vascular portion proximally,
increasing steady traction until cord ruptures and undergoes considerable
elastic recoil (see Section 3.11, p. 120)
• repose any tissue protruding from wound, or resect protruding length of
ductus deferens
• do not handle tissue unnecessarily
• do not become involved in calf restraint
• maintain scalpel and emasculator in bucket with antiseptic and have
second bucket of antiseptic solution for washing scrotum
• local medication is unnecessary
B
C
Complications
• infection – gross contamination at surgery, (rubber gloves!) dirty bedding
• severe swelling – infection, oedema, poor drainage due to small incision
• haemorrhage
• preputial oedema – invariably from extension of scrotal swelling
• tetanus is rare (prophylaxis in at-risk calves)
Bovine Surgery and Lameness, Second Edition
A. David Weaver, Guy St. Jean, Adrian Steiner
Copyright © 2005 David Weaver, Adrian Steiner and Guy St Jean
CHAPTER 7
Lameness
7.1 Incidence
Veterinary practice figures (UK) indicate an average annual incidence of
4– 6% lameness in dairy cows. If treatment carried out by the farmer is
included, however, the true incidence increases to 25 –30%. The incidence
Lameness 199
may range from 3–100% on individual farms. Any farm with an incidence
over 15% should be considered to have a lameness problem which requires
systematic investigation (see Section 7.16). In the intensive agricultural
enterprises common in western Europe and North America:
• facilities for good restraint and ready elevation of hind- or forelimbs ideally
purpose-built for foot work e.g. Wopa crush/chute or a rotating model
• good lighting, hosepipe, water, bucket, brush, and ropes
• left- and right-handed hoof knives
• double action hoof cutters
• hoof rasp
• hoof testers
• straight grooved probe
• grinder for large-scale (i.e. herd) trimming with electrical cut-out in case
of short-circuiting
Economic losses
The direct cost of each lameness case is about £150 ($270), but if such factors
as prolonged calving interval, replacement costs and culling losses are
included, the figure rises to approach £300 ($540) for each lame cow in a
national herd of about three million dairy cows (UK). Losses are similar in USA.
Losses result from:
Hoof traits
Variations in hoof traits relate to survival rates, reproductive performance,
and increased yield from first to subsequent lactations (see Section 7.14
pp. 231–232).
7.3 Terminology
Terms have been introduced to give an acceptable terminology to forms of
lameness common to various countries, where a variety of words have been
Lameness 201
E 13 A
8
D 6 34
13
25
in use. The Latin terms are listed beside the English language equivalent (and
illustrated in Figure 7.2).
Interdigital skin:
L M
4. Interdigital necrobacillosis
2. Solar ulceration 6. Interdigital dermatitis
7. Laminitis
Claw zones
The bearing surface of the claw has been divided into six zones to aid record-
ing (see Figure 7.3). Thus white line separation and abscessation tends to be
in zones one or two, sole ulcer in zone four, and laminitic changes predomin-
antly in zones four and five.
Introduction
Synonyms: phlegmona interdigitalis, ‘foul-in-the-foot’, ‘clit ill’, ‘foot rot’,
interdigital pododermatitis. A peracute form, colloquially ‘superfoul’ has
been encountered in some countries recently.
Definition: acute inflammation of subcutaneous tissues of interdigital space
and adjacent coronary band, spreading to dermis and epidermis.
Lameness 203
5
3
2
Signs
• mild to severe lameness (LS 1–3) of sudden onset, all ages
• interdigital swelling, later involving coronet and pastern
• toes spread apart due to interdigital swelling, initially with unbroken skin
for first 24 hours of lameness
• sometimes more proximal spread, and a secondary interdigital necrosis
very common
• little pus but characteristic foul smell and pain with split in interdigital
skin
Aetiology: interdigital microtrauma and infection with Fusobacterium
necrophorum, Bacteroides melaninogenicus and other organisms.
Pathology: cellulitis and liquefactive necrosis of interdigital skin, with
fissure formation and later, if untreated, development of granulation
tissue, eventually resulting in interdigital granuloma. Advanced cases
can develop digital septic arthritis and other deeper complications. The
disease course is much more rapid in ‘superfoul’ where cows may have to
be culled 48–72 hours after disease onset, due to the extent of destructive
changes.
Differential diagnosis: interdigital foreign body, acute laminitis, solear
penetration by foreign body, severe interdigital dermatitis, interdigital
changes from BVD/MD, FMD, distal interphalangeal septic arthritis, distal
phalangeal fracture.
204 Chapter 7
Treatment
• ceftiofur, ampicillin, LA oxytetracycline, penicillin, sulphonamides (e.g.
trimethoprim-sulpha) systemically
• clean affected necrotic area with disinfectant and apply a topical oxytetra-
cycline or copper sulphate, or BIPP paste (bismuth subnitrate, iodoform
and petrolatum)
• do not bandage, but put on to dry floor or straw bedding, preferably
isolated to avoid spread of infection
• daily cleansing with disinfectant if feasible
• ‘superfoul’: early cases respond well to 6 g oxytetracycline, more
advanced cases to tylosin, careful local débridement under analgesia and
local antibiotic dressing. Isolation is important.
Prophylaxis
• check and improve drainage in areas where interdigital trauma can arise
(e.g. gateways, tracks, stubble)
• improve dry conditions underfoot (straw yard) and increase frequency of
scraper removal of slurry from passageways
• footbaths of zinc sulphate (5–10%) copper sulphate (5%) or formalin (4%)
(see Section 7.15, pp. 234–235)
• antibacterial feed additive: sulphabromomethazine in feedlot outbreak, or
ethylenediamine dihydroiodide for prophylaxis, though results have been
conflicting (North America)
• spread quicklime in muddy tracks or around water troughs
Discussion
Frequent form of digital lameness (e.g. 15% of total), but of relatively lesser
economic importance since the 1980s. Outbreaks of interdigital necrobacil-
losis require methodical investigation of aetiology to develop appropriate
prophylactic measures. Emphasis on major areas for digital trauma (from
yard to parlour to farm tracks) and for potential contamination. Review claw
trimming needs.
Introduction
Synonyms: hyperplasia interdigitalis, corn, interdigital granuloma, interdig-
ital vegetative dermatitis, fibroma, ‘wart’.
Definition: proliferative reaction of interdigital skin and/or subcutaneous
tissues to form a firm mass.
Incidence: usually sporadic, common in certain beef breeds (e.g. Hereford)
and in bulls at AI centres. Occasionally follows severe interdigital disease in
Lameness 205
dairy cows, then is unilateral. May start in yearling bulls, but most clinical
cases (with lameness) are in adults of four to six years.
Predisposition: inherited in some breeds (e.g. Hereford, Holstein Friesian).
Severe interdigital dermatitis or sole ulcer often precedes involvement of
single limb. Frequently associated with poor conformation e.g. splayed toes
with wide interdigital space.
Signs
• slight or no lameness (LS 0–1) depending on size and mechanical interfer-
ence in simple case
• large lesions develop superficial digital traumatic ulceration, and contact
interdigital axial skin may undergo pressure necrosis
• both forms readily become secondarily infected with Fusobacterium
necrophorum
• more or less symmetrical in hindlimbs of beef breeds, especially in bulls,
possibly with bilateral forelimb involvement, which suggests inherited
basis
• single abaxial hindlimb involvement suggests secondary response to
recognised previous insult involving interdigital swelling and sometimes
sole ulcer
Pathology: skin hyperplasia with secondary ulceration. Variable degree of
hyperkeratosis (misnamed papillomatosis).
Differential diagnosis: interdigital foreign body, interdigital necrobacillo-
sis, digital dermatitis.
Treatment
• none if small and asymptomatic
• local caustic (e.g. silver nitrate, copper sulphate) if small and causing
lameness
• most clinical cases require resection by knife surgery electrocautery or
cryosurgery: ideally in Wopa crush under IVRA (intravenous regional
analgesia), bandage (e.g. Vetrap®) after applying sulphadimidine powder.
Remove bandage after one week.
Discussion
Acquired cases develop suddenly in middle of interdigital space; while
congenital cases, manifest as slight swelling in yearling and steadily enlarg-
ing with adulthood, start as fold in the axial skin of the abaxial digit.
Theoretically, breeding policy should be altered to reduce the inheritance
risk of such cases of multilimb hyperplasia. Inheritance may be related to skin
thickness, an alleged slackness of the interdigital cruciate ligaments and the
amount and distribution of body fat.
206 Chapter 7
Introduction
Synonyms: pododermatitis circumscripta, sole ulcer, Rusterholz ulcer.
Signs
• moderate degree of lameness (hesitant, wary gait, slightly arched back,
LS 1) typically up to three months postpartum, masking the frequently
bilateral nature of the lesions, i.e. lateral claw of both hind legs, one more
painful than the other
• severe lameness (LS 2–3) when granulation tissue protrudes and in pres-
ence of deeper purulent infection (osteomyelitis, septic arthritis)
• under-run heel horn exposes sensitive laminae
• contralateral claw: check for similar changes!
• at typical site (see Definition) granulation tissue may protrude through
undermined horn
• under-running commonly extends cranially and peripherally to abaxial
white line
5
5
3 2
4
Figure 7.4 Typical site of sole ulcer of lateral hind claw with adjacent structures
that may be affected by deep sepsis: 1. distal phalanx; 2. deep digital flexor tendon;
3. distal sesamoid (navicular bone); 4. navicular bursa; 5. distal interphalangeal joint.
Treatment
• trim all feet initially or at end
• IVRA (intravenous regional analgesia, see Section 1.8, p. 33)
• remove under-run horn, trim horn of wall and heel so that weight-bearing
by affected claw is minimal
• possibly apply block (hoof resin) to sound claw which should be minimally
trimmed, if weight-bearing cannot otherwise be reduced
• remove protruding granulation tissue, leaving healthy pododerm and
apply tetracycline spray, and bandage (waterproof) for five days
• alternatively, put on sulphadimidine powder, bandage (Vetrap®), and
spray oxytetracycline over bandage to prevent wicking by mud into
bandage
• broad spectrum antibiotics in septic cases
• confine to box and straw bedding for five days
Prophylaxis
• avoid overgrown claws by emphasising need for routine trimming (see
Section 7.14, p. 232)
208 Chapter 7
• avoid factors predisposing to laminitis (see Section 7.9, p. 210) and inter-
digital dermatitis (e.g. excessive moisture)
• do not breed from affected young cows
Introduction
Synonym: pododermatitis septica (traumatica), septic (traumatic) pododermatitis.
Definition: diffuse or localised septic inflammation of solear corium, causing
moderate to severe lameness if purulent.
Incidence: sporadic.
Predisposition: thin solear horn from preceding laminitis (coriosis) exces-
sive abrasion from rough concrete, rough tracks, any tendency to hustle herd
along inside passageways or outside tracks.
Corium (pododerm) has no fatty tissue in toe area, making entry of infec-
tion into distal phalanx easier.
Signs
• sudden onset of lameness (LS 2), usually in hindlimb, with solear
penetration
• site often near toe or adjacent to white line
• defect in horn extends to solear pododerm, with variable under-running
and pus production (black colour)
• localised pain
Aetiology: often iatrogenic following removal of excessive horn during
trimming; also see Predisposition above. Foreign bodies (FB) include stones,
often flints, nails, wire and thorns.
Bacteriology: secondary infection often mixed, including Arcanobacterium
pyogenes.
Pathology: see Definition; Secondary complication is osteomyelitis of distal
phalanx or distal interphalangeal joint (see Figure 7.4).
Differential diagnosis: subacute laminitis, solear ulceration, toe ulcer
interdigital necrobacillosis.
Treatment
• primarily surgical: identify and remove FB; drain after exposure of
under-run horn
• local astringent dressing
• curette distal phalanx if involved
• possibly elevate sole by block on other digit
Lameness 209
Prophylaxis
• avoid predisposing causes contributing to poor quality of solear horn, i.e.
laminitis (coriosis)
• good hygiene (foreign body disposal)
• if track to pasture is hazardous due to flints, consider installation of
‘friendly’ cow track
Introduction
Synonym: white line disease.
Definition: abaxial, or less commonly axial, wall separation from laminae at
sole-wall area extending proximally, with cavity impacted with mud, faeces;
or with development of abscess cavity at deepest part (abscessation).
Incidence: high and in some areas is major cause of digital lameness.
Predisposition and pathogenesis:
Signs
• moderate lameness (LS 1–2)
• white line wider than usual, and in early stages has series of pinpoint dark
marks, later obvious foreign material impacted in white line
• separation evident on paring, no pain
• cases of white line abscessation are lame and have pain localised to wall
• internal wall abscess, without obvious track distally, also very sensitive to
pincers pressure
• advanced cases have supracoronary septic sinus discharge (see Section
7.11, p. 219)
Aetiology: see Predisposition.
Bacteriology: Arcanobacterium pyogenes in abscessation.
Pathology: pressure necrosis of wall laminae, possibly also of solear laminae,
following under-running and septic laminitis tracking progressively more
proximally after entry of purulent micro-organisms, with absence of natural
drainage distally due to impacted material.
210 Chapter 7
Treatment
• routine trimming of all digits
• pare off wall over impacted and septic area to achieve drainage and
prevent further impaction
• also remove all under-run sole (some cases have a large ‘false sole’)
• apply local antiseptic dressing (e.g. oxytetracycline spray) and firm
dressing
• pare horn to normal shape of claw
• consider block on ipsilateral claw
• in septic cases give broad spectrum antibiotics for three days
Radical surgery, possibly amputation, is required in involvement of coron-
ary tissues and distal interphalangeal joint (see Sections 7.11 and 7.12,
pp. 219–225).
Prophylaxis
Avoid predisposing factors for laminitis (coriosis) (see Section 7.9 below), and
ensure regular hoof trimming.
Introduction
Synonym: Pododermatitis aseptica diffusa, coriosis, ‘founder’.
Definition: diffuse acute, subacute, subclinical or chronic inflammation
of pododerm, usually in several digits. Chronic cases without acute stage
(subclinical) are often seen.
Incidence: sporadic acute cases, widespread subacute, subclinical and
chronic cases commonly in dairy units, high incidence in recently calved
heifers and younger cows around parturition. Acute form occasionally pre-
sents as outbreak in barley beef units. Common in beef feedlots.
Predisposition:
Signs
• acute stage: painful hot digit, digital arterial pulsation, general depression,
severe lameness, abnormal stance, possibly recumbent (LS 2–3)
• subacute: less painful but persistent stiffness, stilted gait, solear and white
line haemorrhages (LS 1)
• chronic: stiff gait or not lame (LS 0–1), ‘slipper foot’ malformation with
horizontal lines on wall, concave dorsal wall, widened white line and
evidence of old solear amd white line haemorrhages. See section on
pathology below
Aetiology: see Predisposition and Pathology.
Bacteriology: none.
Pathology: blood and serum exudation in acute stage, later (chronic)
grooves on hoof wall, concave profile, widened white line and flat sole.
Significant sinking of distal phalax due to peripartum slackening of the
connective tissue support structures has been proved; thin sole or ulceration
near tip of distal phalanx (‘toe ulcer’) is evident as haemorrhage (‘bruising’)
as toe tip has no fat layer in its corium. White line lesions may develop into
white line disease (see Section 7.8, p. 209); sole lesions at sole-heel junction
may develop into solear ulceration (see Section 7.6, p. 206).
Histopathology: oedema, haemorrhages and thrombosis in acute stage,
fibrosis and chronic thrombosis in later stages.
Differential diagnosis: bruised sole, white line disease, punctured sole,
solear ulceration all of which may be present (see Figure 7.2).
Treatment
• acute stage: give systemic NSAIDs (flunixine meglumine or meloxicam) or
possibly corticosteroids (only if non-pregnant) and diuretics
• ensure exercise (to improve local circulation and further reduce develop-
ing oedema), preferably by turning on to soft ground, e.g. field
• remove any precipitating dietary causes
• feed no concentrates until acute phase is over
• in recumbent case consider digital nerve block to get heifer or cow to
stand, then forced exercise
• subacute stage: as in acute case
• chronic case: hoof trimming
Prophylaxis
• avoid large amounts of prepartum concentrates (‘steaming up’ ‘lead
feeding’), which should not exceed 2 kg daily
• avoid high intake of concentrate in early lactation, and aim at peak yield
about six weeks postpartum
212 Chapter 7
Discussion
Excess lactic acid production alters rumenal bacterial flora, and causes
release of bacterial endotoxins involving histamine release and stagnation of
blood in laminae of digital horn, with consequent hypoxia and functional
ischaemia. Ischaemic necrosis of the corium and laminae heals by fibrosis.
These tissues then inevitably produce defective (soft, poor quality) horn in
aberrant manner, resulting in signs seen in subacute and chronic stages.
Toxic conditions (mastitis, metritis) may also contribute to development of
laminitis in some dairy cattle.
Introduction
Synonym: dermatitis digitalis, ‘hairy warts’, PDD, papillomatous dermatitis.
Major sites
Minor sites
Signs
• predisposition is not known, but disease affects adult cattle causing vari-
able and often severe lameness (LS 1–3)
• white epithelial border and signs of surrounding chronic dermatitis
• caudally in skin adjacent to heel horn, also occasionally anterior interdig-
ital space, coronary band or in granulation tissue on sole (see Figure 7.5)
• apparently contagious, mostly introduced into ‘clean’ farm by bought-in
heifers which may not themselves show clinical lesions
• role of skin microtrauma as permitting entry of organisms is speculative.
Bacteriology: believed to involve a Treponema genus spirochaete, possibly
also a longer filamentous organism. Other postulated organisms include
Borrelia burgdorferi, Dichelobacter nodosus and Campylobacter spp.
Differential diagnosis: possibly interdigital dermatitis, heel horn erosion,
plantar eczema, but lesions are usually unmistakable.
Treatment
• treat all but most severe lesions in milking parlour
• cleanse with water spray, wait one minute, and apply topical aerosol
antibiotic, e.g. oxytetracycline, daily for three days (long angled nozzle
facilitates spray direction)
• drugs have included oxytetracycline, lincomycin, erythromycin and
lincomycin/spectinomycin, and tylosin
• severe proliferating masses (‘hairy warts’) should be resected through
epidermis (not subcutis) under local anaesthesia (e.g. IVRA, see Section
1.8, p. 35) in crush/chute.
214 Chapter 7
Prevention
• keep feet as dry as possible improving cubicle bedding
• increase use of scraper or equivalent (e.g. 3 times, not twice daily) to
reduce slurry
• check indoor and outdoor tracks for sites of possible microtrauma to heels
• footbath with lincomycin (1 g/litre), mixed lincomycin/spectinomycin (at
33 g and 66 g respectively in total 150 litre water), tiamulin (0.5 g/litre)
or tylosin (1.2 g/litre).
The efficacy of these antibiotics (none of them licensed in the UK and all
forbidden in Dutch footbaths) appears to be decreasing: initially footbathed
through such a mixture once daily for three to five days, the trend is now to
alternate drugs and to use daily for a minimum one week.
• most mixtures lose therapeutic effect after about 300 cow passages (see
Section 7.15, p. 234)
• various other chemical mixtures have also been used with variable results
• isolate any newly purchased heifers for three weeks and check for overt
digital dermatitis lesions, and treat or cull if affected
• disinfect all foot paring instruments (knives, clippers, crush/chute) after
working with an infected herd
Introduction
Synonyms: dermatitis verrucosa, heel warts, ‘hairy warts’.
Definition: moist proliferation of the dorsal and/or plantar/palmar skin,
later developing wart-like proliferations, a common form of digital dermatitis
(see Section 7.10a, p. 212) especially in parts of USA (CA, NY).
Microbiology is similar to the more ulcerative type seen commonly in
Europe.
Introduction
Synonyms: dermatitis interdigitalis.
Definition: inflammation of interdigital skin without extension to deeper
tissues, and variable associated disturbance of horn growth.
Incidence and predisposition: widespread in certain moist housing
systems and wet climates, in all age groups.
Lameness 215
Signs
• mild inflammatory lesions of interdigital skin causing little or no lameness
(LS 0–1)
• bulb horn clefts can lead to contusion of corium and sometimes eventually
to solear ulceration. Lameness may be severe and chronic in such cases.
Aetiology: chronic mild irritation in moist conditions where bacterial infec-
tion is important and significant.
Bacteriology: Dichelobacter nodosus consistently recovered in some areas.
Fusobacterium necrophorum also present.
Pathology: dermatitis characterised by polymorphonuclear cell infiltration
of dermal structures damaged by associated bacterial invasion of germinal
layer.
Hyperkeratosis and parakeratosis can follow. Disintegration of epidermis
may spread to heel horn with contusion of corium and secondary ulceration.
Differential diagnosis: interdigital necrobacillosis, heel erosion, digital
dermatitis.
Treatment
• pare off any diseased horn
• single severe case: interdigital spray with oxytetracycline or copper
sulphate
• multiple cases: formalin or copper sulphate footbath (see Section 7.15,
pp. 234–235)
• regular foot paring
• put into dry housing and dry grazing
• consider formalin footbath for herd control
Prophylaxis
Dry housing and grazing, regular footbaths and foot paring.
Discussion
Interdigital dermatitis has low incidence in UK, despite frequency of heel
erosion (see below). D. nodosus has (1985) been recovered from typical
lesions in the USA.
Relationship of interdigital dermatitis to digital dermatitis is hotly disputed.
Introduction
Synonym: erosio ungulae.
Definition: irregular loss of bulbar horn in form of multiple blackish pit or
pock-like depressions or later deeper oblique grooves, usually affecting hind
digits more severely than fore.
216 Chapter 7
Signs
Slight or no lameness (LS 0–1) except in deep chronic cleft formation, which
may damage corium, cause mild lameness, and lead to under-run heel.
Aetiology: chronic irritation, bacterial infection, interdigital dermatitis.
Bacteriology: Dichelobacter nodosus and Fusobacterium necrophorum.
Pathology: imperfect horn production and destruction. Corium traumatised
by exposure to contusion on edges of clefts. Loss of much heel horn allows foot
to rotate backwards and predisposes claw to sole ulcer as pedal bone increas-
ingly compresses corium at ‘typical site’.
Differential diagnosis: interdigital dermatitis.
Treatment
• single case: pare away diseased and under-run horn, spray topical oxyte-
tracycline gentian violet aerosol on to any exposed corium and transfer to
dry floor
• multiple cases: foot paring, footbaths (formalin) at twice weekly intervals
• if feasible, transfer to dry environment
• if not feasible, put lime into cubicles to disinfect and dry out heel horn
Introduction
Synonym: fissura ungulae longitudinalis et transversalis.
Definition: fissure of horny wall parallel to dorsal wall or parallel to coronet.
An uncommon form is an axial wall crack or fissure.
Incidence: low in dairy breeds, but high incidence (prevalence 37%) found
in some Hereford beef cows in Canada.
Predisposition: transverse form predisposed by overgrowth of digital horn
and severe chronic laminitic horn rings (hardship lines or grooves). Longit-
udinal form predisposed by dry environment, trauma at coronary band.
Signs
• transverse form usually cosmetic blemish only, no lameness
Lameness 217
• single claw form indicates local stress; multiple claws (e.g. all eight) indi-
cates systemic insult e.g. parturition, diet change, altered environment
• pododerm rarely exposed
• longitudinal form may be gross and involve whole length of coronet to
bearing surface
• in other longitudinal cases diagnosis is difficult when fissure is limited to
small and extremely painful coronary lesion, which is partly obscured by
hairs. Such cases have severe trauma to pododerm and early entry of
infection.
• axial wall fissure is also hard to identify and can extend to coronary band
causing severe pain
Aetiology: see Predisposition.
Bacteriology: no role in primary lesion.
Pathology: see above.
Differential diagnosis: transverse form – none. Longitudinal form – often
missed at initial superficial examination of muddy claw. Distinguish inter-
digital necrobacillosis and punctured sole.
Treatment
• transverse form: pare distal section of horn, especially when it forms hinge
with more proximal portion and can cause pain on underlying laminae
when flexed upwards: shorten toe and bearing surface to avoid movement
of fractured portion
• longitudinal form: remove any excessive granulation tissue (pododerm)
protruding through sandcrack
• cleanse well, local astringent, local antibiotic spray, bandage and rest,
possibly with block on adjacent claw especially with painful involvement
of coronary band
• in severe case clean fissure well with grinder or Dremel drill, drill hole at
proximal end of crack and fill with resin, and block other digit
Guarded prognosis in vertical fissures.
Prophylaxis
Regular foot trimming, use of oils on at-risk cattle in dry environment.
Introduction
Unless involving pathological fracture (as in osteomyelitis, see Toe Ulcer
p. 208) this fracture is almost invariably intra-articular (see Figure 7.6).
218 Chapter 7
Signs
• sudden onset lameness (usually medial claw) in fore leg (LS 3), occasion-
ally hind leg
• rarely bilateral
• medial digit of forelimb commonly involved; limb is typically carried
across midline of body to minimise weight-bearing; occasionally cross-
legged stance or leg held forward in stall or cubicle
• no digital swelling, possibly slight heat
• pain on percussion, or pincer pressure and extension (see Figure 7.6)
• flexion of digit resented
• diagnosis on medio-lateral radiograph of affected medial digit (plate
inserted interdigitally), usually intra-articular
Differential diagnosis: acute laminitis, foreign body penetration, bilateral
foreclaw sole ulcers, acute interdigital necrobacillosis, infected vertical
fissure of hoof wall.
Treatment
• untreated animals remain lame for many weeks, as intra-articular
fracture heals slowly
• block sound hoof (see Section 7.26, pp. 255–257), resulting in immediate
improvement and accelerating healing rate
Lameness 219
• also useful to wire toe of affected digit in flexed position to wooden block on
sound digit
• digital amputation rarely indicated
Development
Conditions described in preceding sections involve superficial structures (see
Sections 7.5 and 7.10) and/or the sensitive pododerm (see Sections 7.6–7.9).
Deep digital sepsis can result from the spread of several conditions, listed
below:
Toe ulcer:
• distal phalangeal osteitis
Interdigital necrobacillosis:
• distal interphalangeal septic arthritis
• septic tenosynovitis of digital flexor tendon sheath
• retro-articular abscess of bulb
Signs
Progressively severe lameness (LS 3), possibly leading to recumbency,
pyaemia, weight loss, poor appetite, swelling and erythema around coronet
and pastern, later involving flexor tendon sheath, and extensive distal limb
oedema. Most cases develop a fistulous track.
Treatment
Indications
Indications, in descending order of frequency are:
Advantages
• immediate removal of potentially lethal material (reducing risk of pyaemic
spread)
• relief of pain
• relatively rapid return to thriftiness and production with improved con-
dition and milk yield
• simple surgical technique compared with alternatives
Disadvantages
• potential failure if case selection is poor and infection is present above
amputation site
• persisting poor gait in some heavy cows and bulls due to altered stance
and strain on remaining digit, especially in difficult terrain
• lowered market value
• few cows with amputated digits are retained for more than eighteen
months
Technique
Sedate animal (xylazine 0.1–0.2 mg/kg i.m. or acepromazine 0.1 mg/kg
i.m.) and cast with affected digit uppermost (often lateral hind), or work
with cow standing in Wopa crush (see p. 35). Produce suitable analgesia
by:
• apply tourniquet above fetlock or hock, if not already in position for IVRA
• incise interdigital space close to affected digit along whole length, continu-
ing proximally 3 cm dorsally, and 2.5 cm at plantar aspect
• insert embryotomy (obstetrical) wire into incision and adjust to a level
1–2 cm above axial aspect of proximal interphalangeal joint
• with assistant firmly holding digit down towards ground, saw rapidly at
an oblique angle so that cut emerges 2–3 cm above abaxial joint level,
continuing through skin
• trim off protruding interdigital fat pad
• twist off any major vessels e.g. dorsal digital artery lying axially
• examine cut surface meticulously for signs of s.c. abscessation and
necrosis, peritendinous infection and septic tenosynovitis
• massage distally along deep flexor tendon sheath to check synovia (see
Table 7.1)
• purulent synovia should be irrigated out of tendon sheath (male dog
catheter, 50 ml syringe and saline), and reconsider need for resection of
part of deep flexor tendon
• dress wound with oxytetracycline or sulphadimidine powder (not essen-
tial), apply gauze swab or paraffin-impregnated tulle, and hold in place by
Lameness 223
0 = negative; +, ++ and +++ indicate increasing degrees of severity, N = Neutrophils; WBC = White
bloodcells
Aftercare
• change dressing after two days, when cut surface should be cleaned and
checked for residual infection
• foul odour suspicious
• apply new dressing for six days
• surface may then safely be left exposed for granulation and epithelialisation
• rinse wound with water once daily until healing well
Animal should be kept in dry surroundings, either housed (preferably) or
outdoors on dry level ground, during the three week recovery period.
Disadvantages:
• lengthy procedure
• difficult to locate joint level axially for incision to expose articulation
• liability to break scalpel blades in this awkward site
• preferable use of ‘sage knife’ (a curved solid two-edged instrument) and a
small curette
Discussion
Average survival period following digital amputation in commercial dairy
herds ranges from 12–24 months. Exceptions survive for years. Eventual
reason for disposal is further digital disease in over half of these cattle. In
majority of cases digital amputation has no effect on yield in the lactation
subsequent to the one in which amputation is performed.
Lameness 225
Indication
Prophylactic surgery on medial accessory digits of hindlimbs to prevent
self-inflicted teat trauma. Ethical as well as scientific objections to technique
in Europe, therefore forbidden in many countries including UK and
Switzerland. Common routine procedure in many North American dairies.
Technique
• remove at two to eight weeks old in recumbent calf
• clean and disinfect area
• local infiltration analgesia (2 ml 2% lignocaine plain)
• push digit proximally to move away from joint space and major vessels
• resect through skin margin and dewclaw base with large scissors or
Barnes dehorner, remaining superficial and so avoiding deeper digital
vasculature
• suture any wounds with significant haemorrhage
• apply topical antibacterial powder, dry swab and adhesive tape dressing
for one week
Indication
Extension of infection above level of proposed amputation, without involve-
ment of fetlock joint, is indication for resection of part of deep and superficial
flexor tendons and their sheaths.
Treatment
Indication
Septic tenosynovitis complicating deep digital sepsis.
Treatment
Sometimes removal of deep digital tendon is adequate. Other possible pro-
cedures are removal of deep and superficial tendons with or without partial or
total removal of digital sheath. Precise procedure depends on extent of sepsis
at surgical investigation.
Technique
• useful instruments include a blunt-ended curved tenotome and long
slightly curved scissors
• tourniquet at mid-metatarsal (-carpal) region and IVRA (see Section 1.8,
pp. 33–36)
• trim back accessory claws
• surgical skin preparation to mid-metatarsus (-carpus)
• skin, subcutis and horn of heel bulb are incised over deep flexor tendon
from affected distal area (e.g. sole-heel junction), keeping incision axial to
accessory digit to point 5 cm proximal to fetlock joint
• open sheath along plantar (volar) aspect
• cut through superficial flexor tendon longitudinally over fetlock (where it
encloses deep flexor)
• section deep flexor transversely, just distal to bifurcation (5 cm proximal to
fetlock)
• retract tendon from incision and transect distally at insertion into distal
phalanx
• check any severe involvement of superficial tendon and, if necessary,
resect proximally at same level as deep flexor and at insertion to middle
phalanx
• dissect free and resect any infected tendon sheath and areas of sub-
cutaneous abscessation including curettage as required
Lameness 227
Figure 7.8 Surgical anatomy for removal of superficial and deep digital flexor
tendons following proximal spread of deep infection.
A. incision 12 cm long from proximal to fetlock distally into heel horn; B. sectioned
fetlock ligament; C. opened common digital sheath; D. superficial flexor tendon;
E. deep digital flexor tendon; F. distal cruciate ligament superficial to distal sesamoid
and distal interphalangeal joint.
Indications
Purulent infection of joint and osteomyelitis resulting from spread of
solear ulceration, interdigital necrobacillosis and heel abscess in cases non-
responsive to local débridement and several days high dosage of systemic
antibiotics, and when digital amputation is either not permitted or desirable.
Typically it is a neglected case of solear ulceration (abscess) with severe distal
interphalangeal joint sepsis and osteomyelitis of distal phalanx and distal
sesamoid.
Figure 7.9 Resection of distal interphalangeal joint in deep digital sepsis (right hind
lateral).
A. plantar skin incision (compare Figure 7.8); B. deep digital flexor tendon, resected
distal portion; C. distal sesamoid; D. plantar margin of distal interphalangeal joint.
Technique
• give sedative (xylazine or acepromazine, see Section 1.6, pp. 13–16 and
Section 7.15, pp. 204–205)
• restrain in crush/chute (e.g. Wopa crate, see Section 1.8, pp. 35–36)
• IVRA, ring block or local infiltration (poor analgesia)
• cleanse area thoroughly, clip and disinfect
230 Chapter 7
Knife method
• grasp mass with Allis tissue forceps or Backhaus towel clamp (see Figure
1.1)
• remove whole mass in wedge-shaped pattern by two incisions
• keep fine lip of skin along axial borders from which re-epithelialisation
will start
• remove protruding interdigital fat, avoiding distal cruciate ligaments
(which are easily palpated) and adjacent coronary band
• apply oxytetracycline or sulphadimidine powder, interdigital pressure pad
and figure of eight bandage
• release tourniquet
• wire toes together, especially in heavy animals, with drill holes 2.5 cm
behind point of toe to prevent separation
• no systemic antibiotics, but tetanus antitoxin may be indicated
• do not change bandage unless site becomes infected, or bandage is blood-
soaked
• remove bandage after one week
Electrocautery method
Although a hot iron may be used, the instrument must be small and precise
to reach the interdigital mass without damaging surrounding tissues.
Apply electrocautery loop as in knife surgery above, ensuring integrity of
neighbouring structures especially cruciate ligaments. Advantage is reduced
post-operative haemorrhage, disadvantage is slower healing. Toes should be
wired together after dressing wound with powder
Cryosurgery method
Advantages include absence of haemorrhage and avoidance of post-
operative bandaging and dressing.
Discussion
Recurrence is likely whichever technique is used. Consider foot conforma-
tion, possible inheritance, and trim claws at time of surgery and regularly
thereafter. Recurrence rate may be reduced by keeping wire in place for one
to two months
• length of dorsal hoof wall from coronet to toe (measured with pair of
commercial dividers)
• angle of dorsal wall to ground (protractor)
• heel depth (pair of dividers) (see Figure 7.10)
It was found that:
• cows surviving for three or four lactations had shorter hooves and steeper
angles than non-survivors, based on measurements made during the first
lactation
• heritability of hoof length, employing sire comparisons, increased from
first to fourth lactation
• increases in milk yield from first to second lactation were greater in cows
with short, large-angled hooves in the first lactation
C B D
Figure 7.10 Diagram of vertical section through normal digit of adult dairy cow.
A. dorsal wall: length 75–80 mm (approximately 3 inches); B. bearing surface: length
130 mm (approximately 5 inches); C. dorsal wall angle: 50° forelimb, 55° hindlimb;
D. heel height: 30–40 mm (approximately 11/2 inches).
232 Chapter 7
• first lactation cows with above features had shorter calving to conception
interval following the second lactation
• high yielding cows tend to have longer and lower-angled hooves after
their second parturition
• calving to conception interval within the same lactation was greater in
cows with longer, smaller-angled hooves than in those with shorter,
steeper-angled hooves.
Hoof traits of young cows are associated with their future economic worth.
Since measurements were made from progeny of bulls high on milk yield,
the variations of hoof traits are associated with survival rates, reproductive
performance and increased yield from first to later lactations.
These facts emphasise the necessity to take corrective measures, including
routine chiropody and to review breeding policy in herds where digital over-
growth is a major problem.
Equipment
• single or double action (Hauptner) hoof pincers or ‘nippers’
• right and left hoof knives, Swedish or German pattern
• rotary disk grinder (angle grinder, 10 cm disk)
• hoof rasp
• ropes and hobbles for restraint, hobbles preferably with Velcro® fastening
• appropriate crush/chute, standing or turn-over tilting type
• disinfectant bucket for instruments between cows
• protective goggles (horn particles and dust from grinder), possibly face
mask, gloves and wrist protectors
Lameness 233
Timing of trimming
Ideally at drying off, and again, assuming twice yearly job, at winter housing
or not later than one month before spring turnout but often done when time
is available.
Site of trimming
• preferably under cover, but good light essential
• site should have easy route from collecting area and to outside yard for
later inspection, and be easily cleansed
• check gait (possibly lameness score) and stance when going into crush
• raise hind limb, fix, and clean off mud and slurry with sawdust, straw or
cloth (not water)
• start with minimal trim of medial claw using hoof pincers to shorten
length with vertical cut (‘dumping’) to correct length or height (ideally
7.5 cm length of dorsal wall, but 8 cm acceptable in big-framed cows =
length of cigarette packet) (see Figures 7.10, 7.1[1])
A B
5 5
1
4
3
3
Figure 7.11 Steps in routine foot trimming of dairy cow with overgrown claws.
234 Chapter 7
Discussion
Many dairy cows have grossly abnormal weight distribution of 70:30 on lat-
eral and medial claws respectively. Recent (2003) studies on weight-bearing
have shown that even after the above standard (Dutch method) trimming,
balance has not been restored to the (theoretical) ideal of 50:50, but merely to
60:40. It is vital therefore that minimal amount of horn should be taken from
medial claw.
Pare sole of lateral claw to same level as medial claw, and try to reduce heel
depth to that of medial claw too.
Look at two heels from rear, or lay flat surface (e.g. hoof knife handle)
transversely across heels to confirm their equal height
Ideal dorsal wall angle is 55° (hind) and 50° (forelimb). Ideal dorsal wall
measures 7.5 cm (7–8 cm) from coronet to toe (see Figure 7.10).
7.15 Footbaths
Introduction
The purpose of footbaths is:
Equipment
Preferably two footbaths, in tandem, with first containing water or a mild
detergent mixture, the second the active solution.
Lameness 235
Treatment
Ideally, stand lame cows (e.g. cases of interdigital necrobacillosis, interdigital
or digital dermatitis, heel erosion and possibly solear ulceration) in bath for
20 minutes twice daily. This is rarely practical as it is too laborious on larger
units today.
For preventative treatment walk cattle through after four successive
milkings over a two-day period, then empty, clean and refill with water for
five days. Repeat weekly throughout the year, except when frozen. Note that
a standard bath is inactivated (i.e. bactericidal effect is lost) after 800 cow
passages (e.g. 200 cows × 4 passages, viz. one week recommended usage).
Recent Dutch studies suggest the figure of 800 should be reduced to 300.
Discussion
Regular formalin footbath usage should be practised in herds with an
unacceptably high incidence of interdigital disease, heel erosion and solear
ulceration. The lameness incidence will be reduced, and the severity of lesions
will tend to be less, reducing further the economic losses.
Continued
238 Chapter 7
5. Prophylaxis:
Foot-trimming: practice: none, self, visiting trimmer, vet ______________
frequency/year ______________
technique (e.g. grinder) ______________
Footbath: site ______________
composition ______________
concentration ______________
frequency of replenishment ______________
usage ______________
Quality of stockmanship (including weekend and holiday staff) ______________
1. Identification ______________
2. Number of calves bred ______________
Pregnancy (mo)/number of weeks postpartum ______________
Current yield/expected lactation yield (L) ______________
Current concentrate consumption (Kg) ______________
Body score 1–5 (emaciated-fat) ______________
3. Degree of lameness: severe/moderate/slight/non lame (3–0) ______________
Affected leg(s) LF RF LH RH ______________
Site: upper limb tissue primarily involved ______________
digit (interdigital or horn, lateral or medial claw) ______________
Estimated duration of lameness (weeks) ______________
Previous treatment (medical, surgical, trim) ______________
Diagnosis: major and/or minor ______________
• herd details
• description of lameness problem
• herd investigation
• individual cow investigation
• action recommendations
Numerous factors play interrelated roles in causing this ‘production disease’.
Investigation of herd problem should be done if lameness incidence exceeds
15–20%
Introduction
Joint ill (neonatal polyarthritis) is usually caused by haematogenous
spread of septic infection from the umbilicus, less commonly lungs or liver.
Lameness 239
Signs
• depression, lameness or recumbency, anorexia, dehydration
• joint swelling and pain within 24 hours of onset of infection
• common sites include hock, stifle, carpus and fetlock (hip, shoulder rarely)
• umbilicus may show obvious signs of infection, with pain on deep palpa-
tion (see Section 3.13, p. 123 for routes of spread)
• later nervous signs (e.g. head tremors, opisthotonus) develop in some calves
• ancillary aids: arthrocentesis (cytology, culture!), radiography, ultrasound
Diagnosis
Swelling and pain in several joints (rarely with symmetrical involvement) in
depressed calf are usually diagnostic
Discussion
Meningitis occurs in a minority of neonatal calves, usually in the first week,
and is rapidly fatal. In slightly older calves septic physitis (e.g. of distal radius
or distal tibia) may complicate the initial signs, and radiography then
valuable. ‘Joint ill’ is an emergency requiring rapid control and good nursing,
as well as prompt review of the possible predisposing factors.
Introduction
Most frequently observed congenital anomaly in dairy breeds, and rarely
acquired, congenital flexed tendons (CFT) are usually primarily in the forelegs
and generally bilateral.
Signs
Mild cases have slight carpal flexion and intermittent knuckling of the fore
fetlocks, then bearing weight on the dorsum of the fetlock.
More severe cases can bear weight only on the flexed fetlocks. Advanced
cases, with severe contracture, are often recumbent and, when encouraged
to stand, tend to fall down immediately. Such calves are usually colostrum
deficient, dehydrated and very weak, having failed to suck since birth.
Palpation reveals excessive tension and tautness in both the super-
ficial (SFT) and/or deep flexor tendons (DFT), when attempts are made
to straighten the leg. No pain is evident on extension, and joint swelling is
absent (compare ‘joint ill’ see Section 7.17, p. 238).
Treatment
• in mild congenital cases check immune status and general condition (give
colostrum in first 12 hours postpartum) if doubt exists as to whether calf
has taken maternal milk
• keep with dam for first 24 hours observation in well-bedded loose box or at
pasture, as exercise encourages progressive correction of the milder cases
of flexion of carpus and fetlock joint
• in mild case consider elongation of claw toes with piece of wood glued
to sole
• in more severe case initially correct any systemic problem and consider
applying splint on palmar aspect of limb: from pastern to midmetacarpus
(fetlock flexion) or up to proximal radius (in carpal flexion)
Lameness 241
• select lightweight splint material e.g. split PVC piping. Pad limb (bandage)
meticulously before fitting splint. Lift calf if unable to stand up initially
• alternatively consider casting limb over padding (e.g. Lightcast), ensur-
ing its easy removal for examination of flexion status after one to two
weeks
Surgery
In severe cases of fetlock and carpal flexion (CFT) surgical correction may be
attempted (see Figure 7.12).
Discussion
The prognosis for CFT is good in calves with a mild deformity, i.e. sporadic
knuckling of fetlocks. Severe fetlock and carpal deformaties often fail to be
corrected despite the tenotomy procedures described above, flexion persists
and locomotion is impossible.
Scrupulous management of splints in neonatal calves ensures avoidance of
skin necrosis at potential pressure sores (see Figure 7.16).
242 Chapter 7
distal
2 1
3
5
4
7
Figure 7.12 Tenotomy of superficial and deep flexor tendons and suspensory
ligament over left metacarpus (palmar view).
1. superficial part of superficial flexor; 2. deep part of superficial flexor; 3. deep flexor;
4. superficial part of suspensory ligament (interosseus muscle); 5. deep part of
suspensory ligament; 6. medial vein, artery and nerve; 7. palmar metacarpal veins.
(From Dirksen, Gründer & Stöber, 2002.)
Introduction
Synonyms: tarsal cellulitis, carpal/tarsal ‘bursitis’.
Definition: firm or fluctuating swelling involving pre-carpal bursa and
acquired subcutaneous bursa over lateral aspect of hock.
Lameness 243
Incidence and aetiology: high in housed cattle on hard floors with little
bedding.
Signs
• usually no lameness, no pain, and presents purely as cosmetic blemish
• sometimes skin contusion, break in integument, with seropurulent dis-
charge and invasion by Arcanobacterium pyogenes
• distension of joint capsule, heat, pain and lameness indicate further
localised spread.
Differential diagnosis: precarpal abscessation, septic carpitis, septic tarsitis.
Introduction
Temporary or permanent fixation of patella on upper part of medial femoral
trochlear ridge.
Signs
• stiffness, later jerky action with leg extended caudally for longer than
normal, followed by forward jerk (temporary fixation)
• action sometimes intermittent and limb may become fixed in rigid exten-
sion, dragging claws (permanent fixation)
• position evident on patellar palpation, and manual reposition possible.
Differential diagnosis: displacement of biceps femoris muscle, spastic paresis,
acute gonitis.
244 Chapter 7
9 2
15
13
14
7 8
12 13
4
11
16
X
3
10
5
Treatment
Spontaneous recovery occurs in some individuals, especially cattle at grass.
Complete recovery follows medial patellar desmotomy:
• sedate subject and produce local analgesia over lowest palpable point of
medial straight patellar ligament (see Figure 7.13[11] ), just proximal to
insertion into tibial tuberosity
• clip and disinfect circular area 15 cm in diameter
• make vertical incision 3 cm just cranial to cranial edge of medial patellar
ligament
• insert curved tenotome or bistoury (Hey-Groves pattern) through incision
in vertical manner, into triangular space bounded by middle and medial
ligaments and tibia
Lameness 245
• turn tenotome through 90° and section ligament by short sawing move-
ment and percutaneous pressure with finger
• withdraw tenotome in vertical position, after snapping and separation of
ligament is appreciated
• appose skin edges with two simple sutures
Do not use disposable scalpel blade and handle, due to risk of accidental
breakage and loss of blade, into periarticular area or joint. Check success of
surgery immediately by observing gait; recurrence has not been reported.
Surgery is best performed in standing position, though access to site may be
more difficult in heavy lactating cow than in lateral recumbency.
Complications
• accidental entry into femoropatellar joint (rare)
• accidental section of middle straight patellar ligament (disastrous)
• gross iatrogenic infection of site
• severe haemorrhage
Introduction
Complete or incomplete lateral displacement of patella. Femoral paralysis
caused by dystocia (oversized fetus in anterior presentation, possibly ‘hip-lock’)
may be involved in some cases, therefore check skin sensation over lateral
thigh. Hypoplastic lateral trochlear ridge has been postulated but remains
unproven.
Signs
• gross uni- or bilateral flexion of stifles and hocks
• limb collapses when weight is taken
• patella forms obvious bulge on lateral aspect of joint, and lateral femoral
trochlear ridge is clearly palpable
• manipulative replacement sometimes possible
Differential diagnosis:
Treatment
• joint overlap operation: joint capsule incised medial to patella and closed
by vertical mattress sutures in overlap procedure
• if patella fails to remain in trochlear groove, split fascia of thigh dorsally
from patella
• create new medial patellar ligament by suturing patellar cartilage and
femoral periosteum and fascia, followed by imbrication of joint capsule
medially by simple interrupted absorbable sutures
Treatment
Lateral capsular overlap procedure (see above). Prognosis is poor.
Introduction
Definition: progressive condition characterised by contraction of gastrocne-
mius and related calcanean tendons and muscle bellies, leading to severe
over-extension of hock.
Predisposition: upright stance; certain breeds (e.g. Friesian, Aberdeen
Angus) have hereditary predisposition.
Aetiology: an over-active stretch reflex is present in the gastrocnemius, with
over-stimulation or lack of inhibition of motor neurons. Electromyogram
(EMG) studies indicate increased electrical activity in the gastrocnemius
muscle, and to a lesser extent in other muscles. CSF studies have suggested an
extra-pyramidal dopaminergic central disorder.
Signs
• first seen typically at two to nine months old, rarely congenital or older
animals
• initially unilateral, later often bilateral hindlimb stiffness and increasing
rigidity with heel bulbs raised off ground
• intermittent backward jerking of limb, later over-extension of hock
• raised tail head with occasional upward movement
• leg is readily and painlessly flexed manually, but immediately resumes
over-extended position
Lameness 247
Treatment
Tenotomy of gastrocnemius tendon or tibial neurectomy. Tenotomy often
only temporarily successful in young calves (< 9 months).
1
D
C B
2
3
Figure 7.14 Neurectomy and tenotomy sites for alleviation of spastic paresis.
1. incision site for tibial neurectomy; 2. incision for caudal approach for gastrocnemius
tenectomy; 3. incision for lateral approach for gastrocnemius tenectomy; A. sciatic
nerve; B. tibial nerve; C. peroneal nerve; D. popliteal lymph node.
248 Chapter 7
• identify and mark on skin the groove between two heads of biceps femoris
in standing calf
• operate in lateral recumbency under epidural or GA
• make aseptic surgical approach between two heads of biceps femoris
muscle; popliteal lymph node is useful landmark adjacent to both tibial
and peroneal nerves
• insert wound retractor
• identify the two nerves by electrical nerve stimulator (e.g. cattle goad);
tibial nerve causes digital flexion and hock extension, while peroneal
causes digital extension and hock flexion
• remove 2 cm length of main trunk of tibial nerve, as precise identification
of gastrocnemius branches is difficult or impossible
• suture subcutaneous tissues and skin
• encourage limited exercise for two weeks
Good prognosis follows this neurectomy.
Complications
• continuing muscle atrophy
• temporary or persistent peroneal paralysis
• wound breakdown
• gastrocnemius rupture in heavy cattle one to five days after neurectomy,
possibly due to overstretching of denervated muscle
Introduction
Relatively common condition in younger cows (two to five years), femoral
head usually moving in cranial and dorsal direction.
Signs
• standing animal is obviously lame
• limb appears shortened (in dorsal dislocation)
• characteristic asymmetry of greater femoral trochanters
Lameness 249
3
2
Figure 7.15 Lateral view of left half of bony pelvis showing directions of hip
(femoral head) dislocation or luxation:
1. craniodorsal (frequent); 2. cranioventral; 3. caudoventral into obturator foramen
(palpable).
Treatment
Manipulative or surgical reduction within 24 hours has a good prognosis.
The method varies with the direction of dislocation.
Craniodorsal dislocation
Attempt reduction under deep sedation and muscle relaxation (guaifenesin
5%)
Introduction
The stifle is often the site of non-digital joint problems in adult cattle,
specifically degenerative arthritis. Bilateral spontaneous osteoarthritis may
sometimes be inherited in Holstein and Guernsey cattle, possibly through
a single autosomal recessive gene. Patellar abnormalities are discussed
elsewhere (see Section 7.20, p. 243).
Injuries may primarily affect:
Treatment
Cull cases with cranial cruciate rupture except for purebred or valuable cattle
where surgery may be attempted in a surgical clinic. In other conditions
ensure absolute rest and systemic anti-inflammatory drugs for seven to ten
days. Prognosis is poor.
Introduction
Fractures can affect many bones in cattle including:
Treatment
• external fixation: plaster of Paris (Gypsona®, Cellona®), polyurethane
resin on polyester-cotton fabric (Baycast®, Cuttercast®) or fibreglass
(Deltalite®, Scotchcast®), fibreglass on cotton base (Crystona®) or
polyester polymer on cotton base (Hexcelite®), hanging splint with per-
cutaneous fixation (Thomas splint or walking cast), see Figure 7.16
Table 7.7 Common paralyses of cattle.
Aetiology Dystocia Falls, postpartum Large neonatal calves Pelvic fractures Prolonged lateral
recumbency unique stretch injury recumbency in GA;
252 Chapter 7
Incidence
Common long bone fracture, occasional cases are in neonates, traumat-
ised by dam, others are in growing cattle, less common in mature cows and
bulls.
Signs
Most fractures are in proximal or mid-diaphyseal region of tibial shaft,
oblique and comminuted, with over-riding of the fracture ends. Most are
closed. Compound fractures (open) tend to have wound on medial aspect.
Lameness is severe, with obvious mobility of the distal limb and marked
crepitus at fracture site.
Treatment
While the preferred management is usually transfixation pinning (3 prox-
imal, 3 distal), connected externally by methylmethacrylate side bars
or fibreglass cast, such surgery usually requires referral to a specialist
clinic where controlled traction, sterile facilities, general anaesthesia and
radiology are available. Animals should have stall rest for some weeks. The
transfixation pins should be removed in six to eight weeks, ideally after
radiographic check to confirm fracture healing is appropriate. Minor com-
plications include suppuration around the pin holes. Major problems are
continuing inability to bear weight, leading to severe lateral bowing of the
contralateral hind leg, and failure of adequate callus formation.
Thomas splint cast management is not easy. The device must be ‘made to
measure’ and well-padded over the major pressure points in the inguinum.
Some cattle find it difficult to stand up initially with such a splint.
The use of a resin or fibreglass cast alone in an attempt to immobilise a mid-
or proximal diaphyseal tibial fracture is doomed to failure as it is impossible to
immobilise the stifle joint. This does not apply to fractures of lower limb bones
(e.g. metatarsus/metacarpus), where external immobilisation with a cast is
usually the treatment of choice.
Introduction
Since affected tissue is the cartilage of the growth plate, separation is a more
accurate term than fracture. Majority occur at 0–12 months old. Common
sites include proximal and distal femur, proximal tibia, and distal metatarsus
and metacarpus. The last two forms have recently increased in incidence as a
result of forced traction in beef breed heifers with dystocia caused by absolute
fetal oversize. The latter has a poor prognosis due to severe bruising and
failure of blood to reach the separated epiphysis, which has no nutrient
artery. Osteomyelitis is common sequel.
Introduction
These products are useful in several ways:
Application to digit
Surfaces should be prepared before application of resin
Management
Treatment of osteomyelitis, bone abscess and septic arthritis with systemic
antibiotics presents major problems due to difficulties of penetration, especi-
ally of discrete foci of purulent infection walled off from vascularised tissues.
Appropriate choice (see also Table 1.12 p. 46), based on first examination, is
as follows:
Surgery
Joint drainage procedures for cattle include:
before sensitivity results are available. Ceftiofur Na is often the selected drug
and should be given for two weeks after the joint has returned to normal func-
tion. In cases where the primary source of infection is the umbilicus, surgical
resection is indicated (see Section 3.13, p. 127).
If antibiotics and synovial aspiration do not bring improvement within
36 hours, joint lavage is indicated:
Appendices
1 Further Reading
Anderson, D.E. ed., (March 2001) ‘Lameness’, Veterinary Clinics of North
America: Food Animal Practice, 17, 1, 1–223 (multiple topics)
Andrews, A.H. ed., (2000) The Health of Dairy Cattle: Chapter 10 ‘Internal
cattle building design and cow tracks’ (J. Hughes); Chapter 11 ‘Dairy
farming systems: husbandry, economics and recording’ (D. Esslemont &
M.A. Kossaibati), Oxford: Blackwell Scientific
Blowey, R.W., & Weaver A.D., (2003) Color Atlas of Diseases and Disorders of
Cattle, 2nd edn. London: Mosby
Brumbaugh, G.W., (ed.) (November 2003) ‘Clinical Pharmacology update’
in Veterinary Clinics of North America: Food Animal Practice, 19, 3,
55 –726 (multiple topics)
Cox. J.E., (1987) Surgery of the Reproductive Tract in Large Animals, 3rd edn.
University of Liverpool Veterinary Field Station, Neston, Wirral (clinical
notes, detailed surgical anatomy, line drawings)
Dirksen, G., Gründer H.D., & Stöber, M., (2002) Innere Medizin und
Chirurgie des Rindes, 4th edn. Berlin: Blackwell (German ‘bible’, formerly
Rosenberger)
Dyce, K.M., & Wensing, C.J., (1971) Essentials of Bovine Anatomy,
Philadelphia: Lea & Febiger
Dyce, K.M., Sack, W.O., & Wensing, C.J., (1987) Textbook of Veterinary
Anatomy, Philadelphia: W.B. Saunders
Espinasse, J., Savey, M., Thorley, C.M., et al., (1984) Colour Atlas on Disorders
of Cattle and Sheep Digits: International Terminology, Paris: Point Vétérinaire
Fubini, S.L., & Ducharme, N.G., eds, (2004) Farm Animal Surgery,
Philadelphia: W.B. Saunders
Greenough, P.R., & Weaver, A.D., (1997) Lameness in Cattle, 3rd edn.,
Philadelphia: W.B. Saunders
Hall, L.W., & Clarke, K.W., (1991) Veterinary Anaesthesia, 9th edn. London:
Baillière Tindall
Hickman, J., Houlton, J., & Edwards, G.B., (1997) Atlas of Veterinary Surgery,
3rd edn. Oxford: Blackwell
Kersjes, A.W., Nemeth, F., & Rutgers, L.J.E., (1985) Atlas of Large Animal
Surgery, Baltimore: Williams & Wilkins (excellent colour photographs)
260 Appendices
Leipold, H.W., Huston, K., & Dennis, S.M., (1983) Bovine congenital defects,
Adv. Vet. Sci. & Comp. Med., 27, 197–271
McDaniel, B.T., & Wilk, J.C., (1990) ‘Lameness in dairy cattle’ in Proceedings
of British Cattle Veterinary Association 1990–1991 (from VI Symposium
on disorders of the ruminant digit, Liverpool, July 1990) 66– 80.
(Inheritance of conformation of bovine digit and related longevity of
dairy cows).
National Office of Animal Health Ltd. (NOAH), Compendium of Data Sheets
for Animal Medicines 2005 (UK)
Noakes, D.E., (1997) Fertility & Obstetrics in Cattle, 2nd edn. Oxford:
Blackwell Science
Noakes, D.E., Parkinson, T.S., & England, G.C.W., (2001) Arthur’s Veterinary
Reproduction and Obstetrics, 8th edn. London & Philadelphia: W.B.
Saunders
Pavaux, C., (1983) A Colour Atlas of Bovine Visceral Anatomy, London: Wolfe
St. Jean, G., (ed.), ‘Advances in Ruminant Orthopedics’ in Veterinary
Clinics of North America: Food Animal Practice, 12, 1–298 (March
1996) (multiple topics)
Toussaint Raven, E., (1985) Cattle Foot Care and Claw Trimming, Ipswich, UK.
Farming Press (Dutch method of trimming)
Tyagi, R.P.S., & Singh, J., (1993) Ruminant Surgery, Delhi: CBS Publishers
and Distributors (p. 484, paperback, includes camel and buffalo)
Veterinary Pharmaceuticals and Biologicals (VPB), 2001–2002 12th ed.,
Veterinary Healthcare Communications, 8033 Flint St., Lexena, KS
66214 (index of drugs and US manufacturers and suppliers)
Westhues, M., & Fritsch, R., (1964) Animal Anaesthesia, Vol. 1 Local
Anaesthesia, Bristol: Wright (details of nerve blocks e.g. retrobulbar p. 83
pudic pp. 174–179)
Whitlock, R.H., et al., (1976) Proceedings of the International Conference
of Production Diseases of Farm Animals, 3rd edn. Wageningen, The
Netherlands
Wolfe, D.F., & Moll, H.D., (1999) Large Animal Urogenital Surgery, 2nd edn.
Baltimore & London: Williams & Wilkins (penile surgery, ovariectomy)
Youngquist, R.S., ed., (1997) Current therapy in large animal theriogenology,
Philadelphia: W.B. Saunders (pp. 429–430 ovariectomy techniques)
2 Abbreviations
ABPI Association of British Pharmaceutical Industry
AI artificial insemination
ALT/SGPT alanine aminotransferase/serum glutamin-pyruvic
transaminase
AST/SGOT aspartate aminotransferase/serum glutamic-oxaloacetic
transaminase
b.i.d. bis in die (2 times/day)
Appendices 261
BP British Pharmacopoeia
BVD/MD bovine viral diarrhoea/mucosal disease
BWG British wire gauge
CCF congestive cardiac failure
CCP corpus cavernosum penis
CNS central nervous system
Co coccygeal
CSF cerebrospinal fluid
ECF extracellular fluid
ECV extracellular volume
EDTA ethylene diamine-tetra-acetic acid
EMG electromyogram
FARAD Federal Animal Residue Avoidance
Databank
FG French gauge
GA general anaesthesia
HS hypertonic saline
i.m. intramuscular
i.v. intravenous
L lumbar
LDA left displaced abomasum
mEq milliequivalent
MRL Maximum Residue Limit
NOAH National Office of Animal Health
NSAID non steroidal anti-inflammatory drug
PCV packed cell volume
PDS (monofilament) dioxanone
PGA polyglycolic acid
PM postmortem
PVC polyvinylchloride
RDA right displaced abomasum
RTA right torsion of abomasum
S sacral
SARA sub-acute ruminal acidosis
s.c. subcutaneously
SCC squamous cell carcinoma
SGOT see AST
SGPT see ALT
T thoracic
TA tunica albuginea
t.i.d. ter in die (3 times/day)
TMR total mixed rations
USDA United States Department of Agriculture
USP United States Pharmacopeia
vCJD new variant Creutzfeldt-Jakob disease
262 Appendices
3 Useful addresses
This short reference list is divided into:
North America
American Medical Instrument Corp., 133–14 39th Ave, Flushing, NY
11354 (212 359 3220)
Baxter Healthcare Corp., Pharmaceutical Divn., Valencia, CA (cat. no 9135S
Tru-cut biopsy needle)
Becton Dickinson, Sandy, Utah, UT 84070 (catheters)
Dandy Products, 3314 Route 131, Goshen OH 45122
Ethicon Inc., Route 22, Somerville, NJ 08876
Haver-Lockhart Laboratories, P.O. Box 390, Shawnee Mission, KS 66201
Ideal Instruments, 401 North Western Ave, Chicago, IL 60612
I-STAT Corporation, East Windsor, New Jersey 08520
Appendices 263
Other
Aesculap Werke AG, 7200 Tüttlingen, West Germany (specialist veterinary
instruments)
AMICO GmbH, D7200 Tüttlingen, P.O. Box 65, Trossinger Str. 7, West
Germany (subsidiary of American Medical Instrument Corp.)
Barbot-Génia, 5 rue des Clouzeaux, Parc de la Vertone 44120 (0240302417,
fax 0240031471) www.genia.fr email: sjournal@genia.fr
Concept Pharmaceuticals Pvt. Ltd., 159 C.S.T. Road, Santacruz (East),
Bombay 400-098, India (veterinary instruments)
Coveto, Avenue Louis Pasteur 85607 Montaigu Cedex, France (02 51 48 80
88) www.coveto.fr
Crepin Sarl, 29 avenue de Saint-Germain des Noyers, Z1 BP 77402, Saint-
Thibaud des Vignes, France (01 64 30 01 33, fax 01 64 30 40 73)
www.crepin.fr
Equipement Vétérinaire: (anesthesie) Zone Industrielle Rue de I’Aube,
51310 Esteray, France (03 26 42 50 15, fax 03 26 42 50 16) email:
minerve.equipvet @online.fr
General Surgical Co., 1541 Bhagivath Palace, P.O. Box 1745, Chaudni
Chowk, Delhi 110006, India (veterinary instruments)
H. Hauptner, Kuller Str. 38-44, Postfach 220134, 5660 Solingen, West
Germany (02122 50075) (specialist veterinary instrument maker and
retailer)
264 Appendices
S. Jagdish & C., 12/21 West Patel Nagar, New Delhi 110008, India (instru-
ments)
Jorgen Kruuse Denmark, DK-5290, Marslev, Denmark (459 951511)
Medvet, Ludwig Bertram GmbH, Postfach 644, Spielhagenstr. 20, 3000
Hanover 1, Germany (0511 812081) (specialist bovine instruments,
protective clothing)
Pal Wear Ltd, P.O. Box 144, Protection Works, Oadby, Leics LE2 5LW (dis-
posable gloves, overshoes, oversleeves, trousers, coveralls, etc.)
Portek Ltd., Bleaze Farm, Old Hutton, Cumbria LA8 OLU (01539
722628, fax 01539 741282) email: info@portek.co.uk (cow blocks
and glue)
Reckitt & Coleman, Pharmaceutical Division, Dansom Lane, Hull HU8 7DS
(01482 26151)
Smith & Nephew Healthcare, Healthcare House, Goulton Street, Hull HU3
4DJ (01482 222200, fax 01482 222211)
Surgical Systems Ltd., 5 Lower Queens Road, Clevedon, North Somerset,
BS21 6LX email: david@surgicalsystems.freeserve.co.uk, www.surgi-
calsystemsltd.co.uk
Teisen Products Ltd., Bradley Green, Worcs B96 6RP (01527 821488, fax
01527 821665) (hoof tape, teat bandage, tar hoof dressing)
North America
American Giltspur Inc., P.O. Box 49433, Sarasota, FL34230 (‘Cowslips’,
3 sizes)
AVSC (American Veterinary Supply Company), P.O. Box 9002, Knicker-
bocker Ave., Bohemia, NY 11716
American Hospital Supply Co., 6600 W. Touhy Ave, Chicago, IL 60648
Baxter Healthcare Corp., Pharmaceutical Div., Valencia, CA (cat. no. 9135S
Tru-cut biopsy needle)
Becton Dickinson & Co., Lincoln Park, NJ07035, also Sandy, Utah, UT84070
(catheters)
Davis & Geck, American Cyanamid Company, Pearly River, New York, NY
10965
Davol Inc. ( Johnson & Johnson Company) (1 800 332 2761), www.
vetsurgicalexcellence.com
Dispomed, 1325 DeLanuadiere Joliette, Quebec J6E 3N9, Canada
Ethicon Inc., Route 22, Somerville, NJ 08876
Haver Lockhart Laboratories, P.O. Box 390, Shawnee Mission, KS 66201
Johnson & Johnson, 501 George St, New Brunswick, NJ 08903
Jorgensen Laboratories, 1450 Van Buren Av., Loveland, CO 80538 (800
525 5614), www.jorvet.com, info@jorvet.com
Monoject Divison, Sherwood Medical, St Louis, MO 63103
NASCO Farm & Ranch, 901 Janesville Ave., Fort Atkinson, WI 52538 0901
Pfizer Animal Health, 812 Springdale Drive, Exton, PA 19341
Provet, P.O. Box 2286, Loves Park, IL 61131 (815 877 2323)
Purdue Frederick Co., 50 Washington St, Norwalk, CT (manufacturer of
Betadine surgical scrub)
Sigma Chemical Co., P.O. Box 14508, St Louis, MO 63178
Smith & Nephew, Memphis, TN
Travenol Laboratories Inc., 1425 Lake Cook Rd, Deerfield, IL 60015
266 Appendices
Other
Alcyon, 41 rue des Plantes, 75014 Paris (01 53 90 39 39, fax 01 53 90 39
38) www.alcyon.com
Barbot-Genia, 5 rue des Clouzeaux, Parc de la Vertone 44120 (02 40 03 24
17, fax 02 40 03 14 71) www.genia.fr email: sjournee@genia.fr
B. Braun, Melsungen, Germany (supplied by Arnolds)
B. Braun medical S.A.S., 204 avenue du Marechal Juin, F92107 Boulogne,
France Cedex (01 41 10 53 00 fax 01 41 10 53099)
Centravet Materiel, ZA des Alleux, BP 360, 22106 Dinan, France (02 96 85
80 64, fax 02 96 85 80 65) email: materiel @centravet.fr
Coveto, Avenue Louis Pasteur, 85607 Montaigu Cedex, France (02 51 48 80
88) www.coveto.fr
Equipement Vétérinaire: (anesthesie) Zone Industrielle Rue de l’Aube, 51310
Esteray, France (03 26 42 50 15 fax 03 26 42 50 16) email:
minerve.equipvet@online.fr
Demotec (Siegfried Demel) Brentostr. 21, D61130 Nidderau, Germany (49
6187 21200, fax 49 6187 21208); www.demotec.com (FuturaPad,
Easy Bloc, claw-cutting discs)
Medvet, Ludwig Bertram GmbH, Lübeckerstr. 1, 30880 Laatzen, Germany
(49) 5102 917 590, fax (49) 5102 917 599, email: mvinfo@medvet.de,
www.medvet.de (cage magnet ‘CAP-Super-11’)
Sigma Chemie GmbH, Am Bahnsteig, D8028, Taufkirchen, Germany
North America
American Association of Bovine Practitioners (AABP), P.O. Box 1755, Rome
GA 30162 1755 www.aabp.org email: aabphorg@aabp.org (706 232
2220, fax 706 232 2232)
American College of Veterinary Surgeons, 11N. Washington St., Suite 720,
Rockville, MD 20850 www.acvs.org email: acvs@acvs.org (301 610
20 00, fax 301 610 0371)
American Veterinary Medical Association, 1931 N. Meacham Rd, Suite 100,
Schaumburg, IL 60173 4360 www.avma.org (1 847 925 8070, fax 1
847 925 1329)
AVMA Professional Liability Trust, email: richard. Shirbroun@avmaplit.com
(800-228-7848 ext. 4669) or rodney.johnson@avmaplit (ext. 4645)
Bovine Practitioner, 3404 Live Oak Lane, Stillwater OK 74075, USA
Center for Veterinary Medicine, USDHHS, 7519 Standish Place, Rockville,
MD 20855-0001 (307 827 3800 or 1 888 INFO FDA)
Cornell University Online Consultant: www.vet.cornell.edu/consultant/
consult.asp from College of Veterinary Medicine, Cornell University,
Ithaca, NY 14853 6401 (607 253 3000, fax 607 253 3701)
FARAD enquiries: FARAD@ncsu.edu or FARAD@ucdavis.edu or
www.farad.org
Food Safety & Inspection Service, USDA, Washington, DC 20250
www.fsis.usda.gov (202 720 7025, fax 202 205 0158)
FDA/CVM: drugs: 888-FDA-VETS (888 332 8387)
Food Animal Residue Avoidance Databank (FARAD): www.farad.org; (888
USFARAD (919) 829 4431 or (916) 752 7505)
Hoof Trimmers Association Inc., 4312 Wild Fox, Missoula, MT 59802-3607
(866 615 4663, fax 406 543 1823), www.hooftrimmers.org/ (quar-
terly newsletter)
USDA Meat & Poultry hotline: 800 535 4555
USDA National Animal Health Monitoring Systems (NAHMS), Fort Collins,
CO 80523
268 Appendices
Other
European College of Veterinary Surgeons (ECVS) Office, University of Zürich,
Faculty of Veterinary Medicine, Equine Hospital, Winterthurerstr 260,
CH8057 Zürich, Switzerland (41 1 635 8404 or 41 1 313 0383, fax 41
1 313 0384) email: ecvs@vetclinics.unizh.ch www.ecvs.org (monthly
Veterinary Surgery)
Federal Veterinary Office, Schwarzenburgstr. 161, CH-Bern Switzerland
(www.bvet.admin.ch)
Federation of Veterinarians of Europe (FVE), 1 Rue Defacqz, B-1000 Brussels,
Belgium www.fve.org email: info@fve.org (32 2 533 7020; fax 32 2
537 28 28)
Société Francaise de Buiatrie, BP 11 F-31620 Castelnaud’estrefonds, France
(05 62 14 04 50, fax 05 62 14 04 69) email: buiatrie@wanadoo.fr
e.claire@wanadoo.fr www.e-claire.fr (rubrique SFB)
Swissmedic., Erlachstr. 8, CH-3000, Bern 9, Switzerland (equivalent to FDA)
(www.swissmedic.ch)
World Association for Buiatrics Secretariat, Dr. G. Szenci, Secretary General,
Szent Istvan University, Faculty of Veterinary Science, P.O. Box 2, H1400
Budapest, Hungary www.buiatrics.com email: oszenci@univet.hu
Multiplication factors
Index