Application of Vulvar Sutures

The application of vulvar sutures is a key technique in managing vaginal, cervical, or uterine prolapse in large animals, particularly cattle.

One of the simplest and most effective methods is the simple vulval tape retention suture, which acts as a temporary measure to prevent recurrence of prolapse (cervico vaginal prolapse and total uterine prolapse) after manual correction. 

Simple Vulval Tape Retention Suture

Indications

Simple vulval tape retention suture is one of the simplest, most common and effective method to retain a simple or recurrent vaginal, cervical or uterine prolapse in cattle.

It is a temporary measure to control prolapse.

Restraint

• If the animal is standing, it is retrained in a trevis.
• If recumbent, the hind quarter should be elevated using either conventional methods or a hind quarter elevator device.
• Administer sufficient amount of epidural anaesthesia using 2% lignocaine HCl to produce analgesia of the perineal skin to about 3 cm below the ventral commissure of the vulva.

Materials Required

• Gerlach’s perivaginal needle
• Sterile cotton umbilical tape
• Povidone iodine
• Scissors

Procedure

• Clean and thoroughly disinfect the anus, vulva, prolapsed parts, perineal skin and the tail.
• Return the prolapsed part to its proper position.
• Locate the vulvar hairline on one side (located at least 2-3 inches lateral to the vulvar lips) and swiftly pass the needle subcutaneously from the dorsal commissure parallel through the entire vulval lip out of the ventral commissure.

• This affords a much tougher and thicker skin for the suture, which does not tear out as readily nor cause as much irritation as one in the vulvar lips.
• Place one hand in the vagina for proper orientation of the needle and to maintain it at a depth of about 5-6 cm until the eye of the needle emerges through the ventral commissure.
• A piece of sterile cotton umbilical tape, 30 cm long, dipped in povidone iodine is threaded through the eye of the needle and in one stroke pulled out through the dorsal commissure.
• Like wise repeat the procedure on the other side.
• Both the ends are tightened and securely tied towards one side. The excess ends of the tape are cut short.
• It is desirable to use a type of suture that can be untied or released.

Buried Purse String Suture (Bhuner’s Method)

Buried purse string suture (Bhuner’s method) is used for the vulva following replacement of a prolapsed vagina described by Pierson, Arthur (1966) and Woelffer.

This technique may be used in chronic post partum prolapse as well as prepartum prolapse.

Under epidural anaesthesia and with a near sterile procedure, two one-half inch incisions are made one to two inches above the upper commissure and below the lower commissure of the vulva.

With a long eye point needle, a Gerlach’s perivaginal needle, similar to a seton needle, an 18 inch piece of one-eighth inch nylon cord or heavy vetafil is passed within the tissues from one incision to the other lateral to one vulvar lip.

The needle is withdrawn and reinserted in the opposite direction lateral to the opposite vulvar lip to the lower incision site and again withdrawn.