Student A was participating in an external rotation during their clinical year of veterinary school with Dr. C. Dr. C and Student A were presented with a five-year-old miniature horse stallion for castration. Dr. C supervised while Student A performed the castration. The stallion was examined and both testes were palpated in the scrotum. The stallion was anesthetized and placed into lateral recumbency, and the owner assisted with restraint while Dr. C and Student A scrubbed and administered local anesthesia to the surgical site. Surgery was initiated with the removal of the down testicle, and while the emasculators were in place on the down testicle, surgery was begun on the up testicle. The second testicle was more challenging to exteriorize, and Student A placed emasculators with Dr. C watching.
Upon cutting, Dr. C recognized that the shaft of the penis had been included in the emasculation, resulting in severe penile laceration. Dr. C explained to the client what had happened and recommended referral for a penile repair attempt. Due to the guarded prognosis, the client elected euthanasia.
Does this case raise any red flags?
In the late 19th century, William Halsted identified several principles of surgery to achieve favorable outcomes. These principles of surgery, which are still upheld today, include:
- Careful tissue handling and anatomic surgical dissection
Preservation of blood supply
Maintenance of aseptic technique
Minimum tissue on tension
Accurate tissue apposition
Obliteration of headspace