ring to engage the internal abdominal oblique muscle 3 cm from the first site. Both sutures are then tightened and tied simultaneously, with care taken to not constrict the spermatic cord. An overlapping suture pattern with non‐absorbable suture is used to close the external boarders to the inguinal ring (Figures 18.23 and 18.24). Enough room should be left adjacent to the spermatic cord for two fingers to pass through the inguinal ring. The parietal vaginal tunic is closed with a simple continuous pattern of absorbable suture, and the subcutaneous tissues of the inguinal area are closed to eliminate dead space. The skin is then apposed with a continuous interlocking pattern of non‐absorbable suture [17, 18].
Figure 18.21 Exposure of inguinal ring. MB, Medial border of inguinal ring; LB, lateral border of inguinal ring; SC, spermatic cord.
Source: Image courtesy of Darcie Sidelinger and Heath King.
Figure 18.22 Caudal retraction of internal abdominal oblique (IAO) muscle. MB, Medial border of inguinal ring; LB, lateral border of inguinal ring; SC, spermatic cord.
Source: Image courtesy of Darcie Sidelinger and Heath King.
Figure 18.23 Sutures preplaced through medial and lateral borders of inguinal ring. MB, Medial border of inguinal ring; LB, lateral border of inguinal ring; SC, spermatic cord.
Source: Image courtesy of Darcie Sidelinger and Heath King.
Figure 18.24 Completed closure of inguinal ring.
Source: Image courtesy of Darcie Sidelinger Heath King.
Closure of the inguinal ring following unilateral castration is less complicated. Following ligation and transection of the spermatic cord, the lateral borders of the inguinal ring are closed with a series of preplaced simple interrupted or cruciate sutures. Large non‐absorbable suture can be used or the author has also utilized #4 braided polyglactin for closure. Regardless of the approach chosen, broad‐spectrum antibiotics are administered on the day of surgery and continued for five days. Non‐steroidal anti‐inflammatory drugs are also useful to control postoperative pain and inflammation. Recovery in a small lot versus a stall provides exercise, which helps to reduce postoperative swelling and edema.
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19 Restorative Surgery of the Prepuce and Penis
Richard M. Hopper and Dwight F. Wolfe
Department of Clinical Sciences, College