Surgery of Feet, teat, eye and tail

What is the least-worst option for epidurals in cattle, sheep and pigs?

Pronestesic or Procamidor

(licensed, no specific contraindications, do not contain cholorcresol)

What are the problems around using an epidural in cattle?

Any licensed for cattle specify “Not for epidural”

Only options for epidural usage is via cascade (without MRLs established or specify “not to be used in animals for human consumption”)

What sedation can we use in farm animals (large ruminants only, not pregnant)?

Xylazine and Detomidine

What general anesthetics (in the field) can be used in farm animals?

Ketamine

What does dose 1 sedation of Xylazine specify?

**WE MUST SPECIFY IN EXAMS WHAT LEVEL OF SEDATION THIS WAY

sedation, with a slight decrease of muscle tone, ability to stand is maintained

What does dose 2 of Xylazine specify?

**WE MUST SPECIFY IN EXAMS WHAT LEVEL OF SEDATION THIS WAY

Sedation, marked decrease of muscle tone and some analgesia, usually remain standing but may lie down

What does dose 3 of Xylazine specify?

**WE MUST SPECIFY IN EXAMS WHAT LEVEL OF SEDATION THIS WAY

Deep sedation, further decrease of muscle tone and a degree of analgesia, animal lies down

What does dose 4 of Xylazine specify?

**WE MUST SPECIFY IN EXAMS WHAT LEVEL OF SEDATION THIS WAY

Very deep sedation, a profound decrease in muscle tone and a degree of analgesia, animal lies down

In general what should you give farm animals pre-operatively?

antibiotics? (broad spectrum, decided if short or long acting)

NSAIDS (all cascade)

In general what should you give farm animals post-operatively?

Antibiotic 3-5 days

NSAID (for as long as you think)

What one of three NSAIDs can you use after farm animal surgery?

Meloxicam, Ketoprofen, or Flunixin (off license for surgery use)

What should you remember about giving NSAIDs?

Nothing licensed beyond 5 days

What are the indications for a toe amputation? (7+)

toe necrosis, non-healing ulcer, nonhealing white line disease, vertical fissure, septic. arthritis of distal interphalangeal joint, osteomyelitis of distal phalanx or navicular bone, tenosynovitis of deep flexor tendon, others

What questions should you ask when selecting a case for digit amputation?

Is the other claw on same foot healthy with no lesions?

Are the other 3 feet healthy with no lesions?

Is any infection contained, below the level of surgical incision?

Is the cow otherwise well, no co-morbidities?

Can farmer cope with post op wound management?

Does the farm have a clean and dry pen to house the cow post op?

Does the farm have slats?

WELFARE?

Do you think this should be amputated?

No

Do you think this should be amputated?

No

What preparation and restraint should you do for a digital amputation?

Antibiotics, NSAIDs, crush or foot trimming crush, lift foot with rope/ratchet, sedating in crush very risky as cow might go down (could cast cow), clip and surgical prep

What do the top blue arrows point (purple lines) to in this diagram of digit amputation?

tourniquet placement (higher if higher site + use padding)

What does the green circle point to in this diagram of digit amputation?

clip area

What does the red line in the leg indicate in this diagram of digit amputation?

lateral digital vein

What does bottom blue line in the leg indicate in this diagram of digit amputation?

Dorsal common digital vein

Tell me about the anesthesia for digit amputation. Include what to use, how much and how to give, how long it lasts, etc.

Use Intra Venous Regional Anesthesia (IVRA), apply tourniquet, use local (avoid adrenaline) IV if possible, give 20-30 ml in superficial vein using butterfly catheter, wait 10 minutes, check it worked, ± local infiltration (ring block around coronary band)

lasts ~90 minutes but tourniquet should only be on 60 minutes

Why was this not a good surgical candidate?

Foot is swollen beyond surgical amputation site

What are the potential sights of a digit amputation?

Distal P1, PIP joint, DIP point (alway midway through P2)

higher = better

What does this image show?

possible digital amputation locations

What does this image show?

DIP digital amputation

What does this image show?

PIP digital amputation

What does this image show?

Mid/Distal P1 digital amputation

How do you preform a digital amputation?

Scalpel incision, 2.5cm deep into interdigital space to seat the embryotomy wire

use wire to cut though bone and skin at 90 degrees to the leg

twist and pull any blood vessels, make assessment for ascending infection

What do you do post operatively for a digit amputation?

bandage before removing tourniquet, apply pressure with the bandage, change after 2 days then twice a week until full bed of granulation tissue (bad bandage worse than no bandage)

4 days antibiotics and NSAIDs

How do you apply a bandage with a toe amputation?

Melonin contact layer, lots of cotton wool, knitted bandage (TIGHT), vet wrap, duct tape

How do you preform a removal of interdigital growth/hyperplasia?

pre and anesthesia same as digital amputation, get hold of mass with allis tissue forceps and incise skin around mass and dissect below ± suture then bandage

or electrocautery

What surgery does this image need?

removal of interdigital growth/hyperplasia

What other foot surgeries can you do?

partial toe amputation

radical section (deep surgical curettage of infected/necrotic horn

Why perform teat surgery?

“slow milker” or blockage

What does #1 point to in this teat?

Venous plexus (blood supply in vertical orientation)

What does #2 point to in this teat?

rosette of furstenberg (muscle - proximal aspect of streak canal and end of mucosa)

What does #3 point to in this teat?

teat cistern (sinus)

What layers of tissue are present in a teat?

Skin, submucosa, and mucosa

How should you restain a cow for teat surgery in a parlor?

good height for teat access, rope behind cow, ± kick bar

How should you restain a cow for teat surgery in a crush?

accept the awkward height, ± kick bar, ± lift leg

How should you sedate a cow for teat surgery?

light so they don’t go down or heavy so they don’t get up

How should you apply local to the teat?

avoid adrenaline

ring block, 20 ml, 23 g 1.5 cm needle

Other than a ring block how might you apply local to the teat?

Inverted V (depends on wound orientation), Tourniquet/clamps and IVRA, teat cistern infusion (if polyp, 10 ml)

What do you do pre-op for teat surgery?

California milk test (CMT) to establish based line result

Antibiotics (intramammary or parenteral or both), remember withdrawal periods

NSAID

Cannula = allows drainage of milk but opents teat to infection if used long term

What emergency teat surgerys are likely to have a poor prognosis? (6)

age > 6hr, orientation - horizontal, streak canal involved, milk visible (cistern), base involved, painful

What is the prognosis of this wound?

guarded

What is the prognosis of this wound?

guarded

What is the prognosis of this wound?

Unsure, but likely guarded

What is the prognosis of this wound?

guarded

What is a superficial teat wound description?

intact teat cistern

What is a deep teat wound description?

communication with teat cistern with milk drainage from the wound

What is a longitudinal teat wound description?

oriented with the long axis of the teat

What is a transverse teat wound description?

transects the teat

What is a liner/complex teat wound description?

ex Y shape

What is a proximal teat wound description?

near the base of the teat

What is a distal teat wound description?

near the tip of the teat

How do you treat a teat wound which is only in the skin with no milk visible?

Teat bandage (?Ab and NSAID)

cold compress

How do you treat a full thickness wound with milk visible?

Debride wound, 3 layer closure → mucosa, submucosa/connective tissue/muscle, skin

What suture do you use for a teat closure in the mucosa and submucosa layers?

small diameter and absorbable (Vicryl 4-0, 1.5 metric)

3mm bites, vertical = continuous, horizontal = interrupted

What suture do you use for a teat closure in the skin?

smallish diameter, non absorbable (10-14d), monofilament (Prolene 3-0, 2 metric)

5mm bites, simple interrupted

What should you do post op for a teat surgery?

± teat bandage

start milking when swelling decreased and healing starter (sooner = better) * Use milking machine or cannula NOT BY HAND

ongoing antibiotics minimum 5 days for full thickness or 3 days for partial thickness

ongoing NSAID 3-5 days

What are complications that can occur with teat surgery? (7)

mastitis, wound breakdown, nonhealing, skin infection, fistula formation and milk leakage, edema, fibrosis/narrowing of canal due to scar tissue

What conditions can cause teat obstructions AKA hard or slow milkers?

congenital, teat peas, neoplasia, chronic inflammation

If a teat is blocked what should you do first?

establish location/size/attachment by rolling between finders, probing, ultrasound, radiography or theloscope (endoscopy)

How do you treat teat obstructions in heifers?

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

How do you treat teat obstructions in adults if its at the base?

teat spiral slowly into canal to catch tissue then apply traction to pull out

How do you treat teat obstructions in adults if its at the mid point?

dilate teat and remove with forceps

How do you treat teat obstructions in adults if its at the end?

try plug or teat knife

What causes heifers to get teat obstructions most often?

narrow/atesia of streak canal

What causes adults to get teat obstructions most often?

more complex, underlying issue or polyp

When should you amputate supernumerary teats?

ideally before 4 weeks old

How do you amputate a supernumerary teat?

get the right teat!

local 1 ml depending on age/size

forceps on base crcd direction or burdizzo if large to constrict blood flow

scalpel incision straight across ± suture

How do you amputate a teat due to disease?

restraint and anesthesia

cannula to drain milk

junction prox 1/3 + mid 1/3 (blood vessels higher)

clamp forceps or burdizzo (or rubber tourniquet)

scalpel invision straight across

tie off any BV if not burdizzo

open if drainage required

Why would you perform an enucleation?

neoplasia, severe/non healing infeciton, trauma

How do you prepare for an enucleation?

crush and halter to tie head to side of crush

light sedation (or deep sedation and/or GA and down)

NSAID and broad spectrum antibiotics

local anesthetic

What local anesthetic should do you do an enucleation?

4 point retro bulbar block with curved 15 cm needle, 10 ml/site

inject eyelids with local separately

What are the steps of enucleation? (9)

1. clip and clean with dilute iodine

2. suture/allis tissue forceps eyelids shut

3. circular incision right around the eyelid margin as close to the edge as you can

4. cut medial and lateral canthal ligament

5. allis tissues onto eyelid and apply traction in various directions

6. dissect muscle, connective tissue as close to orbit as possible

7. dissect through optic nerve and blood vessel

8. pack globe with swabs

9. stitch eyelid margin, continuous pattern, tighter than normal skin sutures

Why perform a tail amputation?

trauma, dry feces causing tourniquet

routine in lambs

How do you prepare for tail amputation?

NSAID and broad spectrum antibiotic

caudal epidural ± sedation

tourniquet proximal to site of amputation (rubber ring)

clip and surgical prep

Describe the steps of surgery of tail amputation

ID intervertebral joints by manipulating tail

double V shaped skin incision “W” 10 cm above issue and at least 1 cm below next intervertebral joint

undermine skin to reach joint

disarticulation of vertebrae with scalpel

ligate blood vessels

stitch skin - interrupted

What does the orange arrow point to in the tail amputation?

undermine here

What does the thin red arrow on top point to in the tail amputation?

inteded site of amputation

What does the blue arrow point to in the tail amputation?

incision line

What does the thick red arrow on bottom point to in the tail amputation?

lesion