Rajiv Gandhi Institute of Veterinary Education and Research

Department of Veterinary Surgery and Radiology

SURGICAL MANAGEMENT OF TEAT

LACERATION – A CASE REVIEW

S SUBIKSHA
F BATCH
20120072
IV B.V.SC. & A.H.
 Teat injuries are common in dairy cattle, and, compared with other frequently occurring
diseases, these injuries often result in premature culling of affected cows.

PREDISPOSING FACTORS

 Anatomical location
 Pendulous udder
 Increase in the size of the udder and teat during lactation
 Faulty milking practices
 Suckling calves
 Accidental stamping of the teat

COMMON ETIOLOGICAL FACTORS

 Thorns
 Barbed wires
 Treading
All teat wounds should be considered contaminated and carry the risk of mastitis due to
the nature of the trauma.
Management of teat injuries requires surgery and certainly of major type. Restoration of
the teat lumen following teat surgery is still challenging. Early treatment of teat laceration is
required to prevent infection and subsequent economic losses to the farmer. The prognosis of teat
lacerations is guarded with a high incidence of wound dehiscence and fistula formation.
CLASSIFICATION
Teat lacerations are classified according to the duration from time of trauma, the
localization and conformation of the laceration, and the thickness of the lesion (full or partial
thickness). Different prognoses are associated with different classifications.

1. Duration

Teat lacerations are categorized as acute or chronic (more than 12 hours old).
Surgical intervention on the teat is best performed during the first 12 hours after the injury. Later,
swelling of the teat can be too severe to permit adequate reconstruction of the tissue. These
injuries benefit from medical therapy (hydrotherapy and a nonsteroidal anti-inflammatory drug)
(NSAID) before attempting primary closure of the defect (delayed first intention healing) However,
with complex lacerations (inverted ‘‘Y’’ or ‘‘U’’), it is recommended to try primary closure even if the
laceration is older than 12 hours. The repair may partially dehisce, but the portion that heals will
facilitate the surgical revision performed later in the healing process.

2. Localization and conformation

 Simple or complex
 Longitudinal or transverse
 Proximal or distal

A transverse laceration results in more damage to the blood supply resulting in more
oedema, avascular necrosis, and dehiscence postoperatively compared with a longitudinal
laceration. The more circumference is involved, the worse is the prognosis.

Injury to the distal end of the teat compromises the defence mechanisms of the quarter against
mastitis making the animal at higher risk for clinical or subclinical mastitis.

3. Thickness
  Partial thickness (skin to submucosa) – surgical intervention not necessary. Secondary
healing by medical management of the wound may be sufficient. However, contraction
of the tissue during healing can change the alignment of the teat creating problems
during machine milking.
 Full thickness (skin to mucosa with milk leaking out of the incision) – Risk of subclinical
mastitis – surgical intervention necessary

DIAGNOSIS

 Qualitative analysis of milk – PH, California mastitis test

 Quantitative analysis of milk – somatic cell count
 Ultrasonography- Ultrasonography is a non-invasive technique that can be used for
examining the bovine udder and teat to diagnose the pathological alterations such as
congenital changes, inflammation, mucosal lesions, tissue proliferation, foreign bodies,
milk stones, haematoma and abscess (Aruljothi and Balagopalan, 2021 and
Szencziova, and Strapak, 2012).

PRE-OPERATIVE THERAPY


Antibiotics
 Procaine penicillin 22,000 IU/kg intramuscularly [IM] twice a day
 Streptopenicillin 22,000 IU/kg intramuscularly [IM]
 NSAID
 Flunixin meglumine 1 mg/kg intravenously [IV]
 Meloxicam 0.3 – 0.5 mg/kg intramuscularly [IM]
The surgery can be performed in lateral or dorsal recumbency. The author prefers lateral
recumbency because it decreases bloating on animals that have not been fasting.

ANAESTHESIA

Combination of drugs (neuroleptanalgesia) rather than using only an alpha-2 agonist that
worsens bloating in ruminants.
- Xylazine (0.02 mg/kg)
- Ketamine (0.04 mg/kg)
- Butorphanol (0.01 mg/kg) is given IV or IM

The animal is then cast down, and the legs and head are tied. The side on which the
animal will lie is selected according to the location of the laceration.

The mammary gland is shaved, cleaned, and scrubbed. A local block is performed with 2%
Lignocaine HCL. A Ring block is performed at the base of the teat. The teat cistern can be
infused with lignocaine to anesthetize the mucosa.

SURGICAL PROCEDURE

 Wound debridement
The wound is carefully but aggressively debrided and lavaged. All the necrotic tissue
is removed by scraping the tissue with a scalpel blade until viable tissue is exposed (pink and
diffuse bleeding of the tissue). The margin of the skin may need to be trimmed using the scalpel
blade or scissors. A Teat siphon was inserted to maintain the teat patency. The wounds were
debrided and irrigated with 0.5% povidone-iodine solution diluted in normal saline

 Laceration repair
A 3 layer suture pattern is followed.
 If involved, the mucosa and the submucosa are first reconstructed. A linear defect is
reconstructed using a simple continuous pattern with a synthetic absorbable suture material
(Vicryl) of size 3.0 or 4.0 mounted on a swedged-on atraumatic needle
The muscular and subcutaneous layers are closed with a simple continuous pattern with
a synthetic absorbable suture material (Vicryl) of size 3.0 or 4.0. With large skin flaps, it is
recommended to place some walking sutures to decrease dead space. However, doing so will
increase the surgical time and the foreign material and may compromise the vascularization of the
teat.
The skin is carefully apposed with 2.0 synthetic non-absorbable monofilament suture
material using a simple interrupted or cruciate pattern. When severe postoperative oedema is
suspected (transverse or chronic laceration), vertical or horizontal mattress sutures can be used to
decrease risk of wound dehiscence.
Closure of skin can be achieved by disposable skin staples. Skin staples were found to
be inert, with less tissue reactive, better tissue holding capacity, and better tensile strength. It is
very useful in teat wound healing to favour early healing without any wound dehiscence.

 Post-operative care
Postoperatively the surgical site was protected with an adhesive bandage
(Dynafix). A sterile infant feeding tube size No. 10 was placed into the teat lumen and fixed in situ
and was connected to a 2ml disposable syringe which was used to drain the milk and
administration of antibiotics.
An NSAID (flunixin meglumine 1 mg/kg IV, once a day for 3 days) and antimicrobials
(procaine penicillin 22,000 IU/kg IM twice a day for 3 days) should be continued postoperatively.

COMPLICATIONS AND PROGNOSIS

 wound dehiscence
 fistula formation
 mural abscess
 teat cistern fibrosis
 mastitis

CASE DISCUSSION
 Prompt surgery, aggressive debridement, careful reconstruction of the tissue, judicious use of
suture materials, and appropriate postoperative therapy and monitoring are all key points to be
successful in teat laceration surgery.
 Out of 5 cases, four of them were bovine and one was caprine in species. The incidence of teat
lacerations is comparatively higher in goats due to their pendulous udder and large teats
(Singh et al.,2012)
 In the case of a caprine teat laceration, diluted lignocaine HCl was used for ring block since in
goats, it causes toxicity without dilution.
 In case 4, since the animal was six months pregnant, the animal was restrained on standing
position and xylazine was not used for sedation since xylazine has oxytocin life effects.
 In 2 of the cases, the laceration happened while grazing and for the other cases, the aetiology
is unknown. Vertical wounds were predominant and could be due to the anatomical position of
the teat (Premsairam et al., 2018).
 In 2 of the animals, deep lacerations led to teat fistula which was corrected using 3 layer suture
method (Balagopalan et al., 2016).
 Therapeutic phonophoresis @ 1 watt/cm2 was performed for 5 minutes around the surgical site
on the day of surgery and the 10th postoperative day. Phonophoresis is a technique by which
therapeutic ultrasound is used to introduce pharmacologic agents and able to kill bacteria by
activating the sonosensitizers to produce reactive oxygen species, which are reported to be
toxic to microbes during wound healing (Fares et al., 2017).
 Skin staples were found to be inert, with less tissue reactive, better tissue holding capacity, and
better tensile strength (Premsairam et al., 2018 and Guru Nathan et al., 2021). It is very useful
in teat wound healing to favour early healing without any wound dehiscence.

REFERENCES

1. Aruljothi, N., Balagopalan, T. P., Ramesh Kumar, B and Alphonse, R. M. D. (2012). Teat fistula
and its surgical management in bovines. Intas Polivet., 13(1):40-41.
2. A Novel Approach In Treating Teat Wound Using Autologous Peripheral Blood Mononuclear
Cells (PBMC) In A Six Cows – A Clinical Study. N. Gurunathan1, M. Vigneswari1*, S. Tina
Roshini1, N. Arul Jothi2, C. Chimithi3 and N. Arrivukkarasi3
3. Teat Laceration Repair in Cattle. Sylvain Nichols, 3200 Rue Sicotte, St-Hyacinthe, Que´bec,
Canada, J2S 2M2
Teat Laceration Lack of normal echotexture Infiltration of 2 % Lignocaine
of skin, muscular and mucosa. HCl as Ring block

Debridement of Infant feeding tube size 10 in- 3 Layer suture method

the wound edges situ - Teat canal patency

Skin staples Therapeutic phonophoresis Scar less wound healing