directed caudally (Figure 19.16). The laceration is evident as a transverse wound on the caudal aspect of the prolapsed tissues (Figure 19.17), with the severity of preputial tissue damage a result of both severity and duration of the injury (Figures 19.18–19.20).
Figure 19.16 Preputial prolapse on presentation. Note “elephant trunk” appearance.
Figure 19.17 Moderately severe preputial prolapse with tear on ventral aspect that has assumed a transverse orientation.
Figure 19.18 Fresh preputial prolapse with edema and minimal necrosis.
Figure 19.19 Preputial prolapse with severe laceration and minimal edema.
Figure 19.20 Preputial prolapse with laceration and severe edema.
Preputial Prolapse
Minor trauma with prolapse (Grade 1) can be treated with various medications and wrapped. More extensive trauma with swelling and the presence of necrotic tissue (Grades 2–4) requires a more aggressive approach and, because these cases result in fibrosis of the preputial tissue, surgical correction. In any case, medical treatment should be instituted as soon as possible either as the primary end of management or as a necessary precursor for surgery.
Prior to bandaging the prepuce, the wounds should be cleaned and an attempt should be made to replace the prolapse. This can be facilitated with hydrotherapy (water hose spray, showerhead spray, or soaking) (Figure 19.21). Soaking the prolapsed prepuce in a hypertonic solution with any povidone iodine solution also serves to aid in the debridement of the tissue. I (Hopper) add both salt and sugar so that solution will be very hypertonic without being too irritating. Then, after drying, an ointment is applied. I prefer a petrolatum, tetracycline, and scarlet red oil mixture for severely traumatized, necrotic wounds. I utilize less irritating ointments or mixtures for less affected tissue or after several days of treatment when the tissue is less swollen. Options for this are commercially available udder balms, human hemorrhoid ointment, intramammary infusion ointments, or “sugardine” (Betadine™ + sugar). A 6‐ to 10‐inch rigid plastic tube (milk line or equine nasogastric tubes can be used) is then placed within the prepuce to allow urination and the prepuce is wrapped with Elasticon™. In addition to facilitating urination, the placement of the tube helps decrease the circumferential scarring of the preputial orifice, which results in phimosis. Bandage change intervals are dictated by the extent of damage, the bull's tolerance for the bandage, and whether or not you can completely replace the prepuce within the sheath. When the prepuce cannot be replaced, compression bandaging is utilized. In this case, apply the medicated ointment of your choice and cover with orthopedic stockinette prior to wrapping (Figures 19.22–19.24). In any case when the prepuce has been replaced, the use of a purse string suture to maintain retention is strongly discouraged due to the risk of abscess and an increased likelihood of stenosis. The one acceptable application for a purse string retention suture would be to facilitate the safe transport to slaughter.
Figure 19.21 Soaking injured prepuce.
Figure 19.22 Orthopedic stockinette applied over prolapsed prepuce.
Figure 19.23 Latex tube inserted into preputial lumen for urine drainage.
Figure 19.24 Prepuce bandage with Elasticon and with tube held in place.
Bulls with a particularly pendulous preputial prolapse may benefit from a support sling to lift the sheath and prolapsed tissues close to the body. A sling fashioned by cradling the prepuce and sheath in a large piece of burlap or other loosely woven material may be held in place with bungee cords across the bull's back (Figure 19.25). The support sling may be preferred to avoid adhesive scald from repeated bandaging in bulls with especially pendulous sheath or severe prolapse with deep laceration where prolonged treatment is necessary. Alternatively, a reusable support wrap (bull diaper) also employing bungee cords over the back can be utilized (Figure 19.26). Following resolution of swelling (infection/inflammation) a decision is then made to return the bull to use or surgically correct.
Figure 19.25 Support sling fashioned from burlap material and bungee cords.
Figure 19.26 Reusable bull diaper canvass construction with eyelets for attachment to bungee cords and laundry mesh “window” for urine egress.
Surgical Management of Preputial Injury
Avulsion of the Prepuce
Avulsion of the distal prepuce from its attachment on the dorsum of the free portion