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Simplified Castration With the Equitwister
T.A. Turner, D.R. Turoff, J.C...
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The Equitwister is an ideal instrument for use in Equitarian work. The instrument is inexpensive and easy to use. Thus far there have been no complications to castration using the Equitwister. Students have found this an easier technique to master than either emasculators or the Henderson castration device.
1. Introduction
In delivering health care to working equids, castration is the most common surgical procedure performed. In Equitarian work, castration is typically done on a single day in a community during a yearly visit. Due to the lack of ability to follow up on these patients, it is imperative that reliable techniques with few complications be used. In addition, these techniques are often simultaneously taught to local veterinarians or veterinary students. Ideally, the techniques should be simple, easily repeatable, and use equipment that is affordable.
The most common perioperative complication of castration is hemorrhage.1 Other post castration complications are swelling, infection, and evisceration. Swelling and infection are directly related to postoperative care, but hemorrhage and evisceration are directly related to the procedure. Interestingly, closed castration techniques have fewer complications than other techniques.2 However, the size and contents of the vaginal tunics prevent the use of closed castration techniques in some instances.1 This is usually due to the fact that with large vaginal tunics, emasculators cannot achieve sufficient crush to prevent excess hemorrhage. The Henderson tool castration method is a solution to this problem. The technique uses a clamp that can accommodate the entire cord. The instrument is then attached to a battery-powered drill and the testicle is twisted off.3 The twisting technique is not new and has been used on swine for years, not only to reduce hemorrhage, but also to reduce the possibility of evisceration (a common problem in swine). The twisting of vessels to stop hemorrhage was the preferred surgical technique for hemostasis until the advent of absorbable suture for ligatures. The Henderson tool has become a popular method to use for equine castrations, particularly in Equitarian work because of its reliability.
Sustainability is an important goal of Equitarian work. In this context, sustainability may be defined as the ability to continue the spectrum of veterinary work after the Equitarians leave. In this case, the local veterinarians or animal health workers should be able to continue to perform excellent quality castrations. This can be difficult for no other reason than equipment is unaffordable, as good-quality emasculators will cost several hundred dollars. Although cheaper ones can be obtained, it has been the author’s (Turner) experience that cheap surgical tools fail to function properly much more often than expensive instruments made of good materials. In the case of the Henderson technique, the Henderson clamp is expensive, the power drill is expensive, and castrations may be performed in areas without access to recharge batteries, making the tool unusable.
The purpose of this paper is to describe how the Equitarian Initiative and Christian Veterinary Mission developed the Equitwister, the technique for using the instrument, and its successful results.
Instrumentation
The authors developed and tested an instrument that would twist the spermatic cord like the Henderson castration tool but required only manual effort and cost only a few dollars to make. An 18-in., 5/16th stainless steel rod is bent at two right angles so that there is a 9.5-in. shaft, 3.5-in. Crank, and 5-in. handle. A 6-in. piece of the 5/16th-in. steel is bent at an acute angle and welded to the end of the shaft. One-inch PVC is used for the sleeves, which are placed over the shaft and handle that prevent surgical gloves from being entrapped in the instrument as it is turned (Fig. 1). Total cost of materials to make one Equitwister is $4.71 and a couple of hours of time.
2. Materials and Methods
Before performing a castration in the equine patient, a preoperative examination is performed. The scrotum must be palpated (under sedation, if necessary) to confirm the presence of one or both testes as well as to detect any indication of inguinal herniation.3 The presence or history of inguinal herniation is a vital consideration to help avoid evisceration postoperatively. Evidence of inguinal herniation or the absence of one or both testes requires a different surgical technique. Other preoperative considerations include tetanus prophylaxis, antimicrobial administration, and preoperative administration of nonsteroidal anti-inflammatory drugs.
The authors prefer to use general anesthesia when castrating in the developing countries because surgical exposure is improved. In addition, it carries less risk for the surgeon and patient. Various drugs and combinations of drugs can be used. Drug combination familiarity is essential for proper patient monitoring and safety. In addition, one should use only drugs that are locally obtainable. Most commonly, a combination of xylazine and ketamine hydrochloride is used to induce and maintain anesthesia. After induction, the patient is positioned in lateral recumbency. The upper hindlimb is secured with a rope around the pastern and hock. The limb can be secured in any number of ways to protect the surgeons. After recumbency, an antimicrobial scrub is performed on the scrotum and surrounding area. Local anesthetic (10–20 mL lidocaine hydrochloride) is injected into each spermatic cord, the testicular parenchyma, or both. This reduces the need for additional doses of anesthetics as well as retraction of the cord by the cremaster muscle. Standing over the dorsum of the patient, the surgeon has good access to the surgical site and is in a safe position. The midline of the scrotum is cross clamped with two large hemostats or carmalt clamps, and a 5-cm diameter section of skin is excised with scissors. Minimal skin bleeders result. Both testes can be exteriorized from this opening.
The scrotal fascia is stripped from one exteriorized testicle using a dry piece of gauze. The fascia is stripped from the spermatic cord as far proximally as possible. The same procedure is performed on the second testicle. After testicular exteriorization and stripping of the spermatic cords, the most ventral testicle’s cord is wrapped between the forks of the sterile Equitwister castrating tool with the testicle preventing the cord from sliding free (Fig. 2).
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About
Affiliation of the authors at the time of publication
16445 70th Street Northeast, Elk River, MN 55330 (Turner); 3281 Luneman Rd., Placerville, CA 95667 (Turoff); and Horse Science Center, Middle Tennessee State University, Murfreesboro, TN 37167 (Haffner)
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