Castration Flashcards
where do we clip for dog neuter
§Clip the prescrotal region but not the scrotum
open vs closed castration techniques; whats the difference, why do we use open at OVC
Open technique:
§Open the vaginal tunic
§ What you will be doing!
–
Closed technique:
§Don’t open tunic
§Increased risk of abdominal hemorrhage if pedicle slips within the sutured the vaginal tunic
steps for open castration
- Push the testicle forward to prevent trauma the urethra
- Incise the skin on midline and subcutaneous tissues over the testis
- Using digital pressure (squeeze!), extrude the testis from the tissues (at this time it is still contained within the vaginal tunic)
- Then, incise the vaginal tunic to extrude the testicle from the tunic (open technique)
>Now you can see the epididymis, the ductus deferens and the vessels
>The vaginal tunic is attached to the tail of the epididymis by the proper ligament of the testis - This attachment must be separated to proceed with OPEN castration - Place a hemostatic clamp across the tunic where it attaches to the epididymis and digitally separate the ligament of the tail of the epididymis from the tunic
>Leave the clamp on the tunic to provide hemostasis and facilitate return of the cord after ligation - Identify the vessels. Place 2 or 3 Carmalt (or other) clamps on the pedicle
>ligate in crush of C1
>second ligature above first, or in crush of C2 - Cut between C2 and C3 clamp
- Release the pedicle back into the vaginal tunic. Easier if clamp left on vaginal tunic. The vaginal tunic does not need to be surgically closed or partially removed in dogs (except if anomaly / infection)
- Repeat on other side
- close subcutaneous and deep fascial layers (1 layer) and skin layer
open castration ligation options
§One circumferential suture in crush of most proximal clamp – C1
§One circumferential between 1st suture and next clamp - C2
OR
§One circumferential suture in crush of most proximal clamp – C1
§One transfixing between 1st suture and next distal clamp – C2
** Preferred in larger dogs
§Can also place each suture in a crush and move the clamps up to cut in between – the cord is quite long so you have lots of room
how to space sutures for ligation. what happens if there is too much space? how do we cut?
§Place sutures no more than 0.3 to 0.5 cm apart
§Too much space between sutures results in a section of potentially necrotic tissue
§Cut between C2 and C3 clamp - leaving no more than 0.5 cm of tissue beyond the last suture (necrotic tissue) but enough to prevent suture slippage
§Transect along the clamp using a scalpel
§Grasp the ductus prior to removing the Carmalt (not vessels) to see if the vessels are bleeding
§Never grasp below the sutures
how to close subcutaneous and deep fascia (1 layer)
§Simple continuous with buried knots or a few interrupted sutures
§ 3 bites: side, middle, side: start medial & deep to superficial on close incisional edge (1), then lateral superficial to deep on the far edge(3) and pass through the middle section on the way back to end deep by the starting suture end and knot
§ Avoid deep bites on midline: could inadvertently enter urethra
§ Then suture normally taking a bite of each structure (1, 2, 3 = side, middle, side)
how to close skin for castration
§ Cutaneous:
> Simple interrupted
> Cruciate
§ Intradermal (subcuticular)
> *Must burry the knot!
what if the skin isn’t closing over the ‘buried knot’?
§Place a single suture over the knot and remove tomorrow
§Avoid glue and ‘smurfing’
what if the skin isn’t closing over the ‘buried knot’?
§Place a single suture over the knot and remove tomorrow
§Avoid glue and ‘smurfing’
complications of castration and how to deal with them generally
§Scrotal swelling (normal!)
§Scrotal hematoma
> Slipped ligature or small bleeding vessels (tunic, subQ)
§Abdominal hemorrhage
> Ligature slips, especially with closed castration
§Wound infection / dehiscence
*** E-Collar for 7 days
how to prep for and perform feline castration
§Pluck the scrotal hair (less irritating than shaving)
§Bilateral vertical scrotal incisions
§Open castration
§ Open the vaginal tunic and detach it from the tail of the epididymis
feline castration ligation options
§Square knot technique
> Open technique, transect ductus deferens close to the testis and create a few knots between the ductus deferens and vessels
§Single “figure-of-8” knot
> Do not separate the ductus and the vessels
> Single knot
> Secure and faster / less tedious than square knots
§Overhand technique
> Similar to figure of 8 but single knot
> Some feel it is less secure (not proven) but is easier to form
square know feline castration techniqe
- Separate & transect the ductus deferens from the vessels (close to the testis)
- Create knots between the ductus deferens and vessels - avoid including hair or surrounding soft tissues
- Ensure the knots are apposed to one another and square
- Transect the ligated structures no more than 0.5 cm distal to the knots (ischemic tissue)
when is a testicle considered cryptorchid? what type is more common? issues with this condition?
§ Should be descended by 6 months of age
§ Unilateral more common (right > left)
§ Abdominal (most common) vs inguinal
§ Prone to neoplasia (13.6 times) and torsionq
if we castrate a cryptorchid adult dog what should we do with the testicle
submit for histology (r/o neoplasia)
