HOW-TO SESSION: FIELD SURGERY


Fig. 2. Photograph demonstrating proper application of the emasculator with the prominent external assembly nuts facing the testis and the correct perpendicular orientation to the sper- matic cord.


culators in place for 2–3 minutes is sufficient for most horses to provide adequate hemostasis. In older stallions or donkeys, the author will leave the emasculators in place for 4–5 minutes, or transfix the cord with 2–0 polyglecaprone 25a before emas- culation. In addition, donkeys are reported to have relatively large testicular vessels;7 therefore, the au- thor routinely ligates the cord proximal to the emas- culation site with a single absorbable transfixation suture.


Following emasculation, the parietal tunic of the spermatic cord should be grasped with Ochsner for- ceps before releasing the emasculator. Care should be taken not to clamp across the entire width of the cord, because this would preclude being able to iden- tify a bleeder should it be present. The emascula- tor is released, the cord gently replaced into the scrotal incision to relieve any remaining tension on the cord, and the end of the stump examined. If no bleeding is evident, it can be released. The end of the transected cord should not be blotted or manip- ulated because this could disturb the existing clot and predispose to hemorrhage. After both testes are removed, the scrotal inci-


sions should be examined for any excessive or pul- satile hemorrhage. If excessive hemorrhage is identified, it may be clamped with a Carmalt forceps or ligated (see hemorrhage). The scrotal skin inci- sions should be manually stretched with two fingers until a sudden but small release in skin tension can be felt (Fig. 3). This will allow for maximal drain- age and prevent premature healing of the incisions. Care should be taken to stretch only the skin, and not the underlying subcutaneous tissues or vascula- ture that could result in inadvertent tearing of one of the branches of the external pudendal vein. Postoperatively, the author prefers to keep the horse confined to a stall or small paddock for 24


Fig. 3. Photograph demonstrating stretching of the scrotal skin incisions to promote adequate drainage. The skin should be stretched until a small, but noticeable release in skin tension is felt.


hours for close observation for hemorrhage, prolapse of subcutaneous tissue, omentum, or intestine, and maturation of the clots on the testicular artery. After this 24-hour period, the horse should be ac- tively exercised (lunge or trot) for 5 to 7 days to promote drainage, prevent premature closing of the incision sites, and minimize scrotal swelling.


3. Results


When complications do occur it is important that the client or veterinarian recognize them early, and that they are treated promptly and correctly to minimize prolonged morbidity and client dissatisfaction.


Edema/Swelling


Some degree of postoperative swelling and edema is expected after routine castration; being most evi- dent 3 to 4 days after surgery with complete resolu- tion in 12 to 14 days. More severe swelling that results in clinical signs such as a stiff gait, reluc- tance to ambulate, or abnormal urination is consid- ered abnormal and should be evaluated. Excessive scrotal swelling is usually due to the scrotal inci- sions being too small or not being stretched ade- quately after surgery, or noncompliance of the owner related to active postoperative exercise rec- ommendations. This can result in premature clo- sure of the incisions and accumulation of serous fluid in the scrotum. Excessive swelling may also be a sign of a localized infection or abscess (see infection). Excessive noninfectious swelling is most easily treated on the farm by sedating the horse, aseptic preparation of the scrotal area, man- ually opening and stretching the scrotal incisions with sterile gloved hands to facilitate drainage, and a 3–5-day course of nonsteroidal anti-inflammatory drugs (NSAIDs). The owner should follow this up with cold-water hydrotherapy and active exercise or


AAEP PROCEEDINGS  Vol. 61  2015 211


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