Veterinary Surgery Techniques and Anesthesia
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Questions and Answers

What are some potential complications from an object penetrating the diaphragm?

Pleuritis and pulmonary abscessation can occur.

How can an object penetrating the pericardial sac affect the heart?

It can cause pericarditis, which may be followed by myocarditis.

Name two techniques for performing a rumenotomy.

Suturing the rumen to the skin and using Weingarth's ring are two techniques.

What is a key benefit of using stay sutures during a rumenotomy?

<p>Stay sutures help stabilize the rumen for easier access during surgery.</p> Signup and view all the answers

What is the purpose of a line block in surgical anesthetic preparation?

<p>A line block provides local anesthesia along the incision line.</p> Signup and view all the answers

Describe the Inverted L block technique.

<p>The Inverted L block involves injecting analgesics into a specific area for regional anesthesia.</p> Signup and view all the answers

Why might infiltration of analgesics lead to edema?

<p>Infiltrating analgesics into the incision line may cause tissue swelling.</p> Signup and view all the answers

What role do towel clamps play in rumen surgery?

<p>Towel clamps secure the rumen to the skin for stability during incisions.</p> Signup and view all the answers

What is done prior to bandaging the dehorned site of a goat?

<p>A topical antibacterial solution is applied onto the dehorning site.</p> Signup and view all the answers

What are the two differing opinions about bandaging after dehorning?

<p>Some surgeons recommend bandaging to prevent myiasis, while others believe the wound should be left open to remain dry.</p> Signup and view all the answers

What should be administered to goats prior to the dehorning procedure to prevent shock?

<p>Goats should be anesthetized or deeply sedated before dehorning.</p> Signup and view all the answers

Describe the primary technique used in cosmetic dehorning.

<p>A rongeur is used to remove frontal bone to allow skin closure over the surgical site.</p> Signup and view all the answers

What local anesthetic techniques are utilized for dehorning goats?

<p>A cornual nerve block and an infratrochlear nerve block are utilized.</p> Signup and view all the answers

Why is lidocaine usage important during the dehorning of goats?

<p>Lidocaine should be used judiciously to avoid toxicity in goats.</p> Signup and view all the answers

What prophylaxis should be performed postoperatively after dehorning?

<p>Tetanus prophylaxis should be performed.</p> Signup and view all the answers

How long should skin sutures remain in place following cosmetic dehorning?

<p>Skin sutures should be removed in 3 weeks.</p> Signup and view all the answers

How should the incision be made during the dehorning procedure?

<p>The skin should be incised 1 cm from the base of the horn.</p> Signup and view all the answers

What instrumentation is necessary for the dehorning procedure?

<p>An obstetric wire saw, Gigli wire saw, or dehorning saw is necessary.</p> Signup and view all the answers

List two possible complications that could arise from dehorning.

<p>Potential complications include sinusitis and myiasis.</p> Signup and view all the answers

What should be done if a bandage is applied to a goat's head after dehorning?

<p>The first bandage should be changed on the second postoperative day.</p> Signup and view all the answers

What steps should be taken to manage hemorrhage during dehorning?

<p>Hemorrhage should be stopped by ligating the superficial temporal artery or twisting it with a hemostat.</p> Signup and view all the answers

Why is the timing of dehorning important in preventing myiasis?

<p>Dehorning should be reserved for the cooler months to minimize the risk of myiasis due to flies.</p> Signup and view all the answers

What preparations are needed around the horn area before surgery?

<p>The area around the horn must be prepared for aseptic surgery.</p> Signup and view all the answers

Where are the scent glands located in male goats related to the dehorning process?

<p>The scent glands are located at the base of each horn.</p> Signup and view all the answers

What is the primary cause of abomasal displacement in ruminants post-parturition?

<p>Abomasal displacement is primarily caused by abnormally high volatile fatty acid levels and excessive fermentation.</p> Signup and view all the answers

What is the most common type of abomasal displacement observed in ruminants?

<p>The left displacement of the abomasum (LDA) is the most common type.</p> Signup and view all the answers

What distinguishes right torsion of the abomasum (RTA) from left displacement?

<p>Right torsion generally presents with more acute clinical signs compared to left displacement.</p> Signup and view all the answers

What happens if the torsion of the abomasum exceeds 180°?

<p>If the torsion exceeds 180°, it is termed a volvulus.</p> Signup and view all the answers

What surgical techniques are commonly used to treat right and left abomasal displacement?

<p>Right-flank omentopexy and right paramedian abomasopexy are commonly used for treatment.</p> Signup and view all the answers

Why was the right-flank omentopexy developed as a surgical option?

<p>Right-flank omentopexy was developed to avoid the need for dorsal recumbency during surgery.</p> Signup and view all the answers

What animal conditions should be avoided in procedures requiring recumbency?

<p>Recumbency should be avoided in animals with compromised systemic conditions, respiratory distress, distended rumens, or pregnancy.</p> Signup and view all the answers

What role does gas accumulation play in abomasal displacement?

<p>Gas accumulation leads to distention of the abomasum, causing it to float up the abdominal wall.</p> Signup and view all the answers

What is the purpose of administering a local anesthetic in an inverted L formation during a paravertebral block?

<p>To block the nerves within the surgical field for pain management.</p> Signup and view all the answers

What is the maximum recommended dose of local anesthetic per kilogram of body weight?

<p>2 mg/kg.</p> Signup and view all the answers

Which nerves are targeted in the paravertebral block for desensitizing the flank area in ruminants?

<p>The 13th thoracic nerve (T13), the 1st and 2nd lumbar nerves (L1 and L2), and the dorsolateral branch of the 3rd lumbar nerve (L3).</p> Signup and view all the answers

Where is the vertical portion of the inverted L local anesthetic block positioned relative to the last rib?

<p>It is caudal to the last rib.</p> Signup and view all the answers

What incision length is generally sufficient for a rumenotomy performed through a left paralumbar incision?

<p>20 cm.</p> Signup and view all the answers

Why is it important to leave sufficient tissue caudal to the last rib during incisions?

<p>To ensure enough tissue is available for suturing.</p> Signup and view all the answers

What technique is used to close the rumen incision after exploration and evacuation?

<p>A simple continuous pattern using no. 1 or no. 2 synthetic absorbable suture material.</p> Signup and view all the answers

What is the purpose of placing two large inverting sutures at the ventral aspect of the incision during a rumenotomy?

<p>To ensure the rumen projects well over the skin edge and to avoid contamination.</p> Signup and view all the answers

What incision is made during the right paramedian abomasopexy procedure?

<p>The transverse abdominal aponeurosis and peritoneum are incised.</p> Signup and view all the answers

In the case of an RDA or RTA during surgery, how can gas be emptied?

<p>Gas can be emptied using a 12-gauge needle and rubber tubing.</p> Signup and view all the answers

What suture pattern is used to incorporate the greater curvature of the abomasum?

<p>A simple continuous suture pattern is used.</p> Signup and view all the answers

What is a key consideration for postoperative management in some animals?

<p>Some animals may develop septic metritis, mastitis, or ketosis.</p> Signup and view all the answers

Why might a mature goat be dehorned?

<p>Dehorning reduces danger to humans and other animals or due to broken horns.</p> Signup and view all the answers

Which nerve needs to be blocked for the dehorning procedure and where is it located?

<p>The cornual branch of the lacrimal nerve, located on the supraorbital process.</p> Signup and view all the answers

What is advised regarding food prior to a goat's surgical procedure?

<p>Food should be withheld for 12–24 hours before surgery.</p> Signup and view all the answers

What is a significant risk if adequate analgesia is not provided during surgery on goats?

<p>Goats can die of shock due to pain associated with the procedure.</p> Signup and view all the answers

Flashcards

Fixation devices

Used to stabilize the rumen during rumenotomy, preventing it from moving.

Rumenotomy

Surgical incision of the rumen (part of the cow's stomach).

Weingarth's ring

A specific device used to fix the rumen to the skin during rumenotomy.

Stay sutures

Sutures used to temporarily attach the rumen to the skin during rumenotomy.

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Towel clamps

Used to hold the rumen to the skin during rumenotomy.

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Surgical preparation (left-flank)

Aseptic procedures (preventing infection) for the left flank area during surgery.

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Regional anesthesia (line block)

Anesthesia method involving injecting analgesic along the surgical incision area.

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Inverted L block

Simplest regional anesthesia method for flank or paramedian interventions.

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Paravertebral Block

A method of regional anesthesia used to desensitize the flank area in standing animals like horses, cattle, sheep, and goats.

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Nerves Targeted (Paravertebral Block)

The 13th thoracic nerve (T13), the 1st and 2nd lumbar nerves (L1 and L2), and the dorsolateral branch of the 3rd lumbar nerve (L3) are targeted for flank desensitization.

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Rumenotomy Incision

A surgical incision made through the left paralumbar region to access the rumen, usually about 20 cm long.

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Rumenotomy Incision Placement

The incision should be made about 5 cm caudal (towards the tail) from the last rib, ensuring enough tissue for suturing.

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Inverting Suture Pattern

A continuous suture pattern used to pull the rumen over the edge of the skin incision, preventing contamination.

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Double Row Suture Closure

A common technique for closing the rumen incision using two separate rows of suture material, one simple and one inverting.

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Local Anesthetic Inverted L Block

A method of local anesthesia where the anesthetic is administered in an inverted L shape to block nerves in the surgical area.

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Local Anesthetic Dosage Limit

The recommended maximum dose of local anesthetic in animals is 2 mg/kg body weight.

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Abomasal Displacement

A condition in cows where the abomasum (fourth stomach) moves out of its normal position, typically to the left or right side.

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LDA & RDA

Left Displaced Abomasum (LDA) and Right Displaced Abomasum (RDA) are the two types of abomasal displacement, indicating the side where the abomasum has shifted.

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Cause of Abomasal Displacement

High levels of volatile fatty acids (VFAs) and excessive fermentation in the rumen cause gas buildup, leading to abomasal distention and eventual displacement.

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RTA

Right Torsion of the Abomasum, a condition where the abomasum twists on its axis, usually occurring on the right side.

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Volvulus

A severe form of RTA where the torsion exceeds 180 degrees, leading to complete blockage of the abomasal outflow.

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Electrolyte Changes in RTA

Animals with RTA often experience significant changes in electrolyte levels, particularly chloride and potassium.

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Right-Flank Omentopexy

A surgical procedure used to treat abomasal displacement by attaching the omentum (fatty apron) to the abdominal wall on the right side.

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Paramedian Abomasopexy

Another surgical technique to treat abomasal displacement, involving attaching the abomasum to the abdominal wall, but in a slightly different location than Right-Flank Omentopexy.

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Right Paramedian Abomasopexy

A surgical procedure to reposition the abomasum (the fourth stomach compartment of a cow) back into its correct position in the abdomen through a right-sided incision.

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What is the main objective of a right paramedian abomasopexy?

To reposition the abomasum back into its correct position in the abdomen, restoring normal digestion.

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How is the abomasum secured during a right paramedian abomasopexy?

The abomasum is stitched to the peritoneum and internal rectus sheath to stabilize its position.

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Dehorning

The removal of horns from goats, often done to prevent injuries to humans or other animals.

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Why are goats dehorned?

Dehorning is performed to prevent injuries from horns, as well as for registration purposes in some breed societies.

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How is pain managed during dehorning?

Goats require sufficient pain relief, as they are sensitive to pain and can experience shock if not properly managed.

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What is the surgical preparation for dehorning?

Food should be withheld from goats for 12-24 hours before dehorning to prevent complications like ruminal tympany (bloating).

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Dehorning shock

A sudden and severe reaction that can occur in goats during dehorning, possibly due to intense fear or pain.

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Methods to minimize dehorning shock

Using anesthesia or deep sedation in goats before dehorning, as well as minimizing pain during the procedure.

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Cornual nerve block

An injection of local anesthetic near the cornual branch of the lacrimal nerve to desensitize the horn area in goats.

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Infratrochlear nerve block

An injection of local anesthetic at the dorsomedial margin of the orbit to block the infratrochlear nerve, reducing pain during dehorning.

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Aseptic surgery

Surgical technique that minimizes the risk of infection by using sterile instruments and techniques during dehorning.

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Dehorning tools

Instruments used to remove horns, including obstetric wire saws, Gigli wire saws, dehorning saws, and rongeurs.

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Hemorrhage during dehorning

Bleeding from the superficial temporal artery that may occur during dehorning and requires control.

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Ligating the superficial temporal artery

A method to control bleeding from the superficial temporal artery during dehorning by tying it off using a suture.

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Dehorning and Frontal Sinuses

When a goat is dehorned correctly, the frontal sinuses are exposed due to the connection between the horn's cavity and the sinus.

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Postoperative Wound Management

After dehorning, a topical antibacterial solution is applied, and the wound may be bandaged to prevent infection and foreign material entering the sinus.

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Cosmetic Dehorning

This method aims to avoid large open sinuses by removing a portion of the frontal bone, allowing the skin to close over the surgical site.

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Suturing in Dehorning

The skin incision is closed with simple interrupted sutures, and the partially closed area is left to heal naturally, reducing the healing period.

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Postoperative Management

Tetanus prophylaxis is essential. Bandages should be changed regularly, and fly prevention is crucial in warm weather to avoid complications.

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Dehorning Complications

Dehorning can lead to reduced milk production, sperm problems, sinusitis, fly infestations, and social status issues within the herd.

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Dehorning Prognosis

While complications are rare, the overall prognosis for dehorning is positive. It's important to plan the surgery carefully to minimize risks.

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Dehorning Timing

Dehorning is best done in cooler months to prevent fly infestations (myiasis), which can be a serious complication.

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Study Notes

A Crash Course in Rumenotomy

  • Rumenotomy is a surgical procedure on the rumen, a compartment in the ruminant digestive system
  • The rumen and reticulum accommodate most of the microbial fermentation during digestion
  • The rumen and reticulum are divided by internal projections (pillae) that externally appear as grooves
  • The ruminoreticular fold separates the rumen from the reticulum
  • The rumen is divided into dorsal and ventral sacs by the ruminal pillars, the cranial and caudal blind sacs by the coronary pillars. A cranial pillar subdivides the dorsal sac further into a ruminal atrium, closely linked to the reticulum
  • Reticular-omasal and esophageal orifices are located in the reticular groove, which runs from the cardia to the fundus

Indications for Rumenotomy

  • Removal of metallic foreign bodies (e.g., nails, wire) related to traumatic reticulitis or reticuloperitonitis
  • Removal of materials (e.g., twine, plastic bags) obstructing the reticulo-omasal orifice
  • Removal of foreign bodies lodged in the distal esophagus or over the base of the heart
  • Evacuation of rumen contents
  • Ruminal impaction
  • Impaction and atony of the omasum or abomasum
  • Traumatic reticuloperitonitis (hardware disease)

Causes of Traumatic Reticuloperitonitis (Hardware Disease)

  • Swallowing metallic objects (e.g., nails, wire)
  • The objects penetrate the reticulum wall
  • Perforation of the reticulum wall allows leakage of ingesta and bacteria contaminating the peritoneal cavity
  • Localized peritonitis can result, often with adhesions
  • The objects potentially penetrate the diaphragm, entering the thoracic cavity, potentially leading to pleuritis and sometimes, pulmonary abscessation and pericarditis. Myocarditis, cessation, or septicemia may also develop

Techniques for Performing Rumenotomy

  • Several techniques are described, including the use of sutures and/or fixation devices for fixing the rumen to the skin
  • Suturing the rumen to the skin before rumenotomy
  • Fixation devices like Weingarth's ring
  • Using stay sutures
  • Use of towel clamps

Anesthesia and Surgical Preparation

  • The left-flank area is prepared for aseptic surgery in a routine manner, with local anesthesia using line block, inverted L block, or paravertebral block
  • Local infiltration along the incision line may compromise wound healing due to edema
  • Inverted L block is a straightforward regional anesthesia technique for laparotomy and laparoscopy in large animals
  • Paravertebral block is utilized to desensitize the flank area for standing procedures in horses, cattle, sheep and goats

Surgical Technique

  • Rumenotomy is performed through a left paralumbar incision (20-25 cm generally sufficient) with the animal standing
  • In large cows, it may be beneficial to place the incision closer to the reticulum by making the incision parallel and caudal to the last rib
  • In rumenotomy, a continuous inverting suture (similar to Cushing pattern) is used to pull the rumen over the edge of the skin incision
  • Two large, inverting sutures are placed at the ventral aspect of the incision to ensure the rumen projects over the skin edge to avoid ventral region contamination
  • The rumen is incised with a scalpel, careful attention is used, which should allow for complete closure at the end of the procedure
  • The rumen incision is closed using a simple continuous pattern using no. 1 or no. 2 synthetic absorbable material

Postoperative Management

  • Postoperative medication varies depending on the indication for rumenotomy
  • Rumen overload often requires intensive fluid therapy, whereas traumatic reticulitis typically requires less intervention. Antibiotics are warranted for foreign body removal from the reticulum. Oral fluids, including mildly osmotic laxatives (e.g., magnesium hydroxide), promote gut motility

Complications and Prognosis

  • Potentially fatal peritoneal contamination may occur if a fluid-tight seal is not produced between the rumen and abdominal wall
  • Incisional swelling and potential infection
  • Peritonitis is likely if the abdominal cavity is explored post-rumen closure, irrespective of cleanliness

Surgical Corrections of Abomasal Displacements and Torsion

  • General abomasal displacement causes are related to rate and size of rumen and reticulum contractions, stomach compartment fullness, a pregnant uterus, and the animal's age
  • The abomasum typically sits on the abdominal floor, with its cranial aspect anchored to the reticulum, atrium, and ventral sac by muscular attachments
  • The pyloric part of the abomasum transverses the ventral abdomen, moving toward the right body wall
  • The abomasal lining comprises thick folds of glandular mucosa; body and fundus mucosa contain peptic glands, pyloric mucosa only mucous
  • At the abomasum flexure, folds diminish to rugae, with a large, highly vascularized thickening (torus) that narrows the pyloric passage

Indications for Abomasal Surgery

  • Abomasal dilation or displacement (left or right side – LDA or RDA) is a common surgical procedure, especially in the first month after parturition
  • There may be high volatile fatty acid (FA) levels, contributing to gas accumulation and distention, leading to displacement/torsion
  • Right abomasal torsion (RTA) can vary in degree and usually presents with marked electrolyte changes (Cl, K levels), compared to other displacements
  • Torsion of over 180° is considered volvulus (a complete obstruction of ingesta outflow to the duodenum)
  • Right paramedian abomasopexy is one treatment option

Surgical Technique for Left-Flank Abomasopexy

  • A 20–25 cm incision is used in the paralumbar fossa
  • Ensuring the distended abomasum does not lie within the incision area is critical
  • A 8–12 cm simple continuous or interlocking suture line (heavy polymerized caprolactam, nylon, or polypropylene) is placed along the greater curvature of the abomasum (5–7 cm from the greater omentum attachment)
  • The serosa may be rubbed with a dry surgical sponge on the abomasum area, improving adhesion formation
  • Using hemostats to hold the suture ends, cranial and caudal, may help with identification before abomasum deflation
  • A 12-gauge needle is used to deflate the abomasum via a dorsal puncture, working at an angle to prevent leakage
  • The cranial end of the suture is affixed to a large, straight or S-curved cutting needle and guided medially along the internal abdominal wall, right of midline, but medial to the subcutaneous abdominal vein and ~15 cm caudal to the xiphoid process.
  • Using an assistant to provide upward pressure on the abdominal wall where the needles are inserted allows better needle access. An empty syringe can be used for this task
  • The caudal suture is ~8–12 cm caudal to the cranial suture, placed through the body wall
  • The assistant grasps both suture ends and applies gentle traction while the surgeon simultaneously positions the deflated abomasum into its correct anatomical placement
  • The suture ends are tied together, with care to achieve appropriate tension to prevent intestinal entrapment or tearing

Surgical Technique for Right Paramedian Abomasopexy

  • 20 cm incision is made between the midline and the right subcutaneous abdominal vein
  • The incision should start ~8 cm caudal to the xiphoid process and extend cranially to the umbilicus
  • Small branches from the subcutaneous abdominal vein, which need ligation due to lack of inherent hemostasis
  • The incision proceeds through the external and internal abdominal oblique muscles, and into the rectus abdominis muscle
  • The transverse abdominal aponeurosis and peritoneum are incised. Removing gas, if present, may also be required
  • Suture patterns: Simple continuous suture pattern is applied for abomasal fixation to the peritoneum and internal rectus sheath (lateral portion of greater curvature), closed with a continuous pattern
  • The external rectus sheath and skin are closed using a Ford interlocking suture pattern

Dehorning the Mature Goat

  • Dehorning is performed for human and animal safety, as well as for breed registration
  • Dehorning of male goats is often combined with removal of the scent glands, especially for odor reduction

Dehorning Procedure

  • Surgical Site Preparation: 1 cm incision is made from the base of the horn
  • The skin is further excised in the caudolateral and caudomedial areas to prevent scar formation
  • An obstetric or Gigli wire saw is inserted caudally and advances in a craniolateral direction, cutting through the bone at the base of the horn
  • The scent glands are also removed at the base of the horn
  • Hemorrhage from the superficial temporal artery is controlled by ligation or pulling and twisting with a hemostat

Postoperative Management for Dehorning

  • Tetanus prophylaxis should be given
  • Bandaged heads should have bandages changed every other day and potentially remain for 5–6 consecutive days, or longer, based on sinus healing. Prevention of flies/myiasis is crucial during the summer months

Complications and Prognosis for Dehorning

  • Dehorning can result in a reduction of milk production
  • Reduced fertility
  • Sinusitis, myiasis, or problems with social interactions within the herd may appear
  • The surgical plan should be designed to reduce the negative impacts
  • Dehorning procedures are relatively safe and successful but need to be performed during cooler months

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Rumenatomy Lecture Notes PDF

Description

Test your knowledge on various veterinary surgical techniques, particularly those related to rumenotomy and dehorning in goats. This quiz covers complications, anesthetic preparation, and surgical procedures essential for successful veterinary practice.

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