orientation as the preputial tissues were retracted toward the preputial orifice."/>
Figure 15.3 Preputial laceration in a breeding bull. The laceration assumed a transverse orientation as the preputial tissues were retracted toward the preputial orifice.
Figure 15.4 Preputial laceration with prolapse of the damaged preputial tissues. Reorientation of the wound results in the elephant trunk appearance of the prolapsed preputial tissue.
Trauma and disruption of the preputial epithelium and underlying elastic tissues is accompanied by inflammation and edema and the open wound inevitably becomes septic. As dependent edema accumulates, the prolapsed tissue increases in size and weight, and traction on the prepuce results in greater amounts of preputial tissue becoming exposed. Additional trauma, mutilation, and desiccation of the unprotected preputial tissues occur and wound contracture at the site of the injury distorts the tissues as the reoriented wound undergoes fibrosis and cicatrix formation (Figure 15.5).
Figure 15.5 Wound contracture and fibrosis at the site of a preputial laceration.
Source: Courtesy of Richard Hopper.
Preputial retractor muscles serve to elevate the prepuce and this elevation can minimize edema formation in damaged tissues. Many polled bulls lack retractor prepuce muscles and preputial prolapse following laceration in naturally hornless bulls tends to become more severe than similar injuries in horned animals [16].
Wolfe and Carson constructed a four‐point classification scheme that incorporates the severity of the preputial injury to estimate the prognosis for return to function and guide treatment decisions (Table 15.1) [17].
Table 15.1 Classification of preputial prolapse.
Source: Modified from [17], p. 258, © 1998, Wolters Kluwer.
| Category | Description | Treatment and prognosis |
|---|---|---|
| I | Simple preputial prolapse with slight to moderate edema without laceration, necrosis, or fibrosis | Either conservative or surgical treatment with good prognosis |
| II | The prolapsed prepuce has moderate to severe edema, may have superficial lacerations or slight necrosis, but has no evidence of fibrosis | Surgery is the usual course of therapy with a good to guarded prognosis |
| III | There is severe edema of the prolapsed prepuce with deep lacerations, moderate necrosis, and slight fibrosis | Surgery is indicated and the prognosis is guarded |
| IV | The prolapsed prepuce has been exposed for quite some time and has severe edema, deep lacerations, deep necrosis, fibrosis, and often abscess | Surgery and salvage by slaughter are the only options, and a guarded to poor prognosis follows surgery |
Medical management of preputial laceration and prolapse is aimed at control of tissue sepsis, reduction of edema, and the eventual return of the damaged tissues to the preputial cavity. Application of emollients to prevent desiccation and topical antibiotics should be combined with light bandaging. Careful cleansing and flushing of the wound with dilute antiseptic solutions and debridement of devitalized tissues is necessary. Topical antibiotic therapy is sufficient if wound management is adequate, and systemic antibiotic therapy is not often required.
Application of a circumferential bandage to protect the wound, prevent desiccation, and apply mild compression of the damaged tissues is useful. To apply a bandage following cleansing and application of an emollient antibiotic ointment, first place a short length of latex tubing into the preputial orifice and position it with one end in the preputial cavity proximal to the torn epithelial tissues and the other end exiting the preputial orifice to allow urine egress from the prepuce. Then place a piece of clean 5‐cm orthopedic stockinette over the exposed preputial tissues and snugly apply an elastic tape bandage over the stockinette, prepuce, and urine egress tube beginning at the distal end of the prolapsed tissue, overlapping the tape as it advances up the prepuce to the preputial orifice, where it can be secured to the haired skin of the sheath (Figure 15.6). Following bandaging, the edematous prepuce may sometimes need to be suspended by application of a bib or sling made of net material or burlap supported by straps encircling the bull's abdomen (Figure 15.7). Frequent bandage changes are necessary, and the wound should be treated locally each time it is exposed. Cold water hosing for 10–15 minutes at each bandage change will reduce edema and remove necrotic debris. With diligent treatment many bulls may be returned to service without surgery [18] but repeat injury is common.
Figure 15.6 Bandaging of the prolapsed preputial tissues following application of an emollient and topical antibiotics. Placement of a urine egress tube to evacuate urine from the prepuce, a light stockinette to protect the exposed tissues (a), and an overlapping elastic tape pressure bandage secured to the preputial hairs and urine egress tube distally and to the skin of the haired sheath proximally (b).
Figure 15.7 Burlap “bib” applied to the bull's abdomen to suspend the edematous preputial tissues.
Source: Image courtesy of Chance Armstrong.
Surgical treatment following preputial laceration can improve outcome [19] and is indicated when the bull's value and remaining breeding life justify the expense [19, 20]. Surgery must always be preceded by preoperative wound management. Excellent descriptions of the surgical options appear elsewhere in this book (see Chapter 19).
Retropreputial Abscess
Preputial injury and laceration are not limited to B. indicus influenced breeds. In B. taurus bulls, preputial injury may occur at the time