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Module 21: Ruminant Production > Surgery: Feet/Claw/Teat/Tail > Flashcards

Surgery: Feet/Claw/Teat/Tail Flashcards

1
Q

what are the indications for a digit amputation

A

Toe necrosis

Non-healing ulcer

White line disease

Septic arthritis of distal interphalangeal joint

Osteomyelitis of distal phalanx (P3) or navicular bone

Tenosynovitis of deep flexor tendon

A lot of these end stage of common foot lesions

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2
Q

what questions should be asked when determining whether or not to amputate a digit

A

Other claw on same foot has no lesions/not lame?

  • No lesions at all because there will be more weight put on it

Other hind foot has no lesions/not lame?

Infection NOT tracked above level of surgical incision?

Cow otherwise well, good BCS, not freshly calved

Can farmer cope with post op wound management?

  • Not suited to every farm

Slats?

One narrow claw can get stuck

Animal welfare most important?

  • Sometimes culling is best for welfare

Realistic expectations (12-24 months max)

  • 55% survival at 1 year post surgery in hind-limbs, and 84% survival in forelimbs
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3
Q

what are pre-op preparations for digit amputation

A

Antibiotics (broad spectrum)

NSAID ‘wind up’

Suitable crush (or down under sedation)

Lift foot, tourniquet

Clip and surgical prep

IV regional anesthesia , 20-30ml convenient superficial vein (licence IV?)

Check it worked!

+/- local infiltration

Lasts about 90 mins but tourniquet should only be on about 60 mins

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4
Q

how do you do an IV regional amputation for digit amputation

A

Lateral digital vein probably best

Wait 10 mins (block other side?)

Diffuses out of the vein and anesthetize the surrounding structures

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5
Q

what are the 3 potential sites for digit amputations

A

Distal part of P1

Proximal interphalangeal (PIP) joint (cartilage)

Distal interphalangeal (DIP) joint (cartilage)

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6
Q

how is a digit amputation done

A

If you expose cartilage you need to use a curette to scrape the cartilage off

Aided by scalpel incision in ID space to ‘seat’ the embryotomy wire

  • 90º

Make an assessment for ascending infection

Twist and pull any blood vessels (tourniquet so won’t bleed)

No skin closure, heals by secondary intention so needs to be kept clean and dry

  • Rely on granulation bed forming
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7
Q

what are the post op procedures following a digit amputation and how do you bandage it

A

Bandage before removing tourniquet

Apply pressure:

  • Melonin contact layer
  • Cotton wool
  • Knit firm
  • Vet wrap (quite tight)
  • Duct tape (water proof)

Change after 2 days then twice/week until full bed of granulation tissue

  • Poorly managed manage worse than no bandage at all!

Continue meds — 4 more days of antibiotics and NSAID

  • At least of 5 day course of antibiotics
  • NSAIDs are not really licensed for long term use — extend withdrawal periods
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8
Q

how do you remove a interdigital growth/hyperplasia

A

Prep and anesthesia same as digit amputation

Get hold of mass with allis tissue forceps

Incise skin around mass and dissect below

+/- suture

Bandage

Alternative = electrocautery

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9
Q

what are the 3 layers of the teat

A
  1. mucosa
  2. submucosa
  3. skin
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10
Q

name the important teat anatomy

A
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11
Q

why is the distal end of the teat important

A

Streak canal is where the teat seals off from environment

Teat cistern — if there is a full thickness wound it is a route of infection into the udder or can end up with fistula formation

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12
Q

what is the venus plexus of the teat

A

If there is a wound at the top it can affect blood supply to the distal teat

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13
Q

how does blood supply run in the teat

A

Blood supply runs in a vertical direction so vertical wounds > horizontal wounds (necrosis)

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14
Q

how should you restrain for teat surgery

A

Kick zone

Sedation (watch don’t go down or big dose so stays down)

Crush

  • +/- kick bar
  • +/- lift leg
  • Awkward height

Parlour:

  • Rope behind
  • +/- kick bar
  • Good height
  • Assistant hold tail
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15
Q

what are further investigations that can be done to examine the teats

A

Palpate (roll between fingers)

  • Polyps or scar tissue

Probe

  • Narrow
  • Obstruction

Ultrasound

Theloscope (endoscopy, not a day 1 skill)

Very precious part of anatomy

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16
Q

what are the local anesthesia blocks for teat surgery

A

Local (try to avoid adrenaline)

Ring block, 20ml, 23g 1.5cm needle

  • Small needle

OR

Inverted V (depends on wound orientation

Tourniquet/clamps and IVRA

Teat cistern infusion 10ml (if polyp)

17
Q

what other pre op procedures for teat surgery are done

A

California milk test (CMT)

  • Is there mastitis? (subclinical)

Antibiotics

  • Intra-mammary vs parenteral
  • Both if full thickness wound
  • Duration depends on infection risks (cascade)

NSAID

  • Painful
  • Inflammation
  • Cascade for long term use

Cannula

  • Allows drainage of milk but to infection if used long term post op
  • Prone to mastitis if not milking
  • Dirty and can introduce infection but helpful to relieve of milk
18
Q

how do you assess teat wounds

A

Age

  • >12hrs not good

Orientation

  • Horizontal not good

Structures involved

  • End = streak canal = teat not sealed 😔
  • Milk visible = cistern = fistula 😔
  • Base = blood supply = necrosis 😔

Pain

Farmers expectations (cull cow vs peak lactation)

19
Q

assess this teat injury

A

Horizontal component but vertical as well
Not involving the distal anatomy
Superficial
Might be okay
Worry about necrosis

20
Q

assess this teat injury

A

Dry and old, need to debride it
Looks full thickness at distal end
Likely going thru streak canal
Poor prognosis

21
Q

assess this teat injury

A

Fresh
Horizontal direction
Near base of teat but there is the venus plexus here

22
Q

how do you treat a skin only teat wound

A

no milk

teat bandage (? abs and NSAID)

cold compress helps with swelling

23
Q

how do you treat a full thickness teat wounds

A

Consider drying off quarter

Debride dead/necrotic tissue

24
Q

how do you close a full thickness teat wounds

A

Mucosa

Submucosa/connective tissue/muscle:

  • Both small diameter absorbable
  • Ex. Vicryl 4-0, 1.5 metric (ie small)
  • Vertical = continuous
  • Horizontal = interrupted (tension)

Skin:

  • Simple interrupted
  • Not too much tension
  • Non-absorbable, monofilament, smallish diameter
  • Ex. Proline 3-0, 2 metric
25
Q

what is the wound post op care for teat injuries

A

+/- teat bandage to protect outside of wound in between milkings

Milk as normal

  • Not by hand as pressure not even and puts tension on suture or cannula

Start milking when swelling decreased and healing started (sooner the better)

On-going antibiotics/NSAID

26
Q

what are teat injury wound complications

A

Mastitis

Fistula formation

  • Non-healing leads to a hole
  • Bacteria entry

Wound breakdown

Fibrosis/narrowing of canal

Edema

27
Q

what are teat obstructions (aka slow milkers)

A

Congenital, teat peas, neoplasia

Ultrasound useful but underutilized (endoscopy in EU)

28
Q

what are the treatments teat obstructions in heifers (aka slow milkers)

A

Narrow/atresia of streak canal

Perforate with needle/small scalpel, daily manipulation to avoid adhesions

29
Q

what are the treatments for teat obstructions in adults

A

More complex, underlying issue or polyp

Base:

  • Teat spiral slowly into canal to ‘catch’ tissue then apply traction to pull out

Mid:

  • Dilate teat and remove with forceps

End:

  • Try plug or teat knife

Open teat surgery EU

30
Q

how is teat amputation of supernumerary teats done

A

Ideally before 4 weeks old

>3 months = vet

Heritable

Get the right teat!

Local anesthetic around teat

Forceps on base cranial caudal direction

Orientation of skin

Burdizzo if large

Scalpel

+/- suture

31
Q

how is teat removal due to injury done

A

Local anesthesia using ring block + sedation

Junction proximal 1/3 + mid 1/3 (blood vessel at base of teat)

Clamp forceps or burdizzo

Scalpel

Tie off any blood vessels (if no burdizzo)

Open — drainage

If toxic mastitis

If for a wound you might close it

32
Q

what are the indications for enucleation

A

Neoplasia,

Severe non-responsive infection

33
Q

describe how to do 4 point retrobulbar block

A

Gently curved 22-gauge 3.5” spinal needle, directed through the conjunctival fornix and along the sclera (not penetrating the globe) at 10 o’clock, 2 o’clock, 4 o’clock and 8 o’clock

At each site the needle is inserted to a depth of 6-10cm and 5-8ml is injected

34
Q

describe the basic steps of enucleation

A

Clip/clean (dilute iodine)

Suture/allis tissue forceps eyelids shut

Circular incision right around the eyelid margin (1cm)

Allis tissue onto eyelid

Traction but watch!!

Dissect muscle and CT — ligament (close to orbit)

Dissect through optic nerve and blood vessel

  • Very difficult to tie off blood vessel because its so deep

+/- pack globe with swabs

Stich margin

Continuous suture pattern

Tighter then normal and close together

35
Q

what are the indications for tail amputation

A

Trauma, tourniquet feces

36
Q

how is a tail amputation done

A

Sedate

Caudal epidural

Tourniquet proximal to site of amputation

Rubber ring for castration

Flutter valve for calcium

Clip and surgical prep

Double V shaped skin incision (10cm above issue)

Undermine flap

Disarticulation of vertebrae

Ligate blood vessels

Stitch skin

Module 21: Ruminant Production (21 decks)

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