Teat and udder surgery

Teat and udder surgery is certainly one of the major areas of soft tissue surgery. In recent years, there have been great advances in what can be accomplished with teat and udder surgery. This article reviews teat and udder surgery from the simplest technique to the most complex. Diagnosis and prognosis are covered, as well as the actual surgical techniques.

Endoscopy mastectomy and breast reconstruction: endoscopic breast surgery

This article describes a new method of external traction elevation which is applied to the breast in order to perform an oncologically thorough glandular removal and axillary dissection followed by immediate autologous reconstruction while significantly reducing wound morbidity and greatly improving cosmesis.

[Teat amputation in cattle--indications, surgical results and economy]

Based on the experience gained after the performance of 204 teat amputations with complete closure of the wound, medical as well as economic aspects were discussed. Various types of severe teat injuries leading to a teat amputation were listed. Surgery was successful in 94.6% of all animals subjected to the teat amputation. Approximately 50% of the animals had a reproductive life span after surgery of more than one year. The most common reasons for culling were inconvenience at milking and insufficient milk yield. The milk yield during a lactation period dropped by an average of 5.5%. Cost efficiency of the procedure was evaluated by partial budgeting. The result of this analysis suggested that in most cases, from the economic standpoint of view, there might be an indication for teat amputation.

[Clarification and treatment of teat stenosis using endoscopy]

In ten cows ten stenotic teats were endoscopically examined and treated. For this purpose two different methods were performed: Either the endoscopy was performed through the teat canal or through a small incision in the side of the teat. The endoscopy through the teat canal proved to be a simple and practical method. However, the results were not always clear-cut, and a controlled operation was not possible. Endoscopy through a side access is more expensive but has several advantages. It allows a good view on the Fürstenbergsche Rosette, one of the most frequent locations of stenosis. Additionally, controlled operations of the level of the Fürstenbergsche Rosette are possible once a suitable instrument has been introduced through the teat canal. The additional trauma caused by the access hole is a minor problem. All cows examined and treated by this method could be milked without any problems three days after the operation.

Microfilariae in the mammary gland of a bitch

A microfilarial infection of the mammary gland of a bitch with Dirofilaria immitis was diagnosed by fine needle aspiration biopsy. The animal had had a progressively enlarging, painful, pendulous, cystic swelling, measuring 12 x 18 cm, in the second left abdominal mammary gland for four to five months. Two separate biopsies revealed microfilariae and mammary duct epithelial cells, but no inflammatory cells. A histological examination revealed atrophic and necrotic mammary lobules with dilated and cystic ducts. Solid carcinoma was also observed in a small area of the mammary mass. The interlobular connective tissue was oedematous and the lymphatic and vascular channels were dilated. Microfilariae were observed within both the small blood vessels and capillaries and in the interlobular stroma of the mammary tissue, but there was no evidence of an inflammatory response.

Silicone toxicology

Silicone, a man-made polymer containing the element silicon, has been used in a variety of medical devices including breast implants. Silicone was used, in part, because it was suggested to have the property of biological inertness. Inert materials do not affect chemical, physiological, or immunological processes. Silicone is not inert. Silicone from breast implants "bleeds" through the surrounding envelope and is present in the surrounding capsule or migrates to other distant locations. Silicone and/or the multiple chemical contaminants elicit foreign body reactions associated with granulomatous inflammation and fibrosis. Silicone and its contaminants have the potential for significant toxicity in the implant recipient.

Postoperative evaluation of the surgical treatment of accessory teat and gland cistern complexes in dairy cows

The purpose of this study was the long-term evaluation of a method of surgically repairing the abnormal condition of accessory teat and gland cistern complexes in dairy cattle. A prospective evaluation of three cows that had undergone the procedure was done. These cows were evaluated from four months to one year, postoperatively. A thorough history, physical examination, contrast radiography, and ultrasonic examination were done on each cow. A retrospective evaluation of an additional 13 cows that had also undergone the procedure was obtained four months to three years following the surgery, via owner communication. The prospective portion of this study demonstrated patency of the communication between main and accessory teat cisterns. Postoperative complications included initial slow milking and mild swelling of the involved teat. These problems resolved in all cows one to two months postoperatively. None of the 16 cows that had undergone the surgery either developed or was treated for mastitis. Likewise, none of these cows was sold or slaughtered as a result of postoperative teat problems or unsatisfactory milk production. Our study demonstrated that this particular method of surgical correction of accessory teat and gland cistern complexes is effective, is esthetically acceptable, produces minimal associated complications, and preserves the milk production capacity of the gland.

An animal model for subperiosteal tissue expansion

An animal model for subperiosteal tissue expansion is described. Small tissue expanders were placed bilaterally and inflated in the buccal subperiosteal pockets of the mandible. Additionally, subcutaneous expansion was performed in the breast region. Twenty-one dogs were used in three experimental groups to evaluate the optimal size of an expander for this model, the optimal inflation regimen, and the histologic changes following subperiosteal expansion. Hemicylindrical expanders, 20 mm in width, 10 mm in height, and 30 mm in length, inflated with 1 mL saline every four days, were used for this model. It was found that the periosteum was replaced by fibrous connective tissue during expansion. Capsule formation following subperiosteal expansion was much more rapid than that following subcutaneous expansion. A greater increase in vascularity was noted in the subperiosteal expansion group and the subperiosteal control group than in the subcutaneous expansion group. In the subperiosteal expansion group, a thick fibrous capsule, with minimal inflammatory response, was observed 1 week after full inflation. Leaving the fully inflated subperiosteal expanders in place more than 1 month accelerated the resorption of the underlying bone. These results support the previously reported empirical regimens of subperiosteal tissue expansion. Furthermore, the excellence of the subperiosteal expanded bed as a recipient site for onlay grafting was confirmed.

Unilateral fibroepithelial hyperplasia of the mammary gland in a goat

A 2.5-year-old female Nubian goat was admitted because of a mass involving the right mammary gland. Ultrasonography and cytologic examination of the mass revealed a benign or hyperplastic condition. A right mastectomy was performed. Results of histologic and immunohistochemical tests indicated mammary fibroepithelial hyperplasia (fibroadenomatous change), which is a condition usually found in cats. The mammary mass had not redeveloped in the goat after 1 year.

MR-guided focused ultrasound surgery

Magnetic resonance guided focused ultrasound surgery provides a minimally invasive controlled method for selectively destroying deep-lying tissue. A thermal analysis of focused ultrasound provides an estimate of the time-dependent temperature distribution and thermal dose required for ultrasound surgery. The temperature distribution is estimated by accumulating heat sources, considering the effects of thermal conductivity, heat content, and perfusion. In this study, both gel phantoms and excised in vitro bovine muscle specimens were imaged in a 1.5 T MR system while heated with a 5 cm diameter, 10 cm focal length, 1.1 MHz transducer. During sonication, the thermal effects were observed with T1-weighted pulse sequences. Below a critical temperature, the heat zone appeared as a dark spot that moved with the focal spot. Above a critical thermal dose, the in vitro tissue was irreversibly altered and the focal lesion was observed on both the MR image and the specimen slice.

Biopsy of the bovine mammary gland

A technique is described for biopsy of the bovine udder, employing sedation and local anaesthesia. Tissue samples of approximately 5 g were obtained by electrocautery from two quarters of the udder of a cow laterally recumbent. Care was taken to ensure complete haemostasis which was achieved by electrocoagulation and ligation. Postoperative recovery was rapid, and loss of yield was no greater in biopsied glands than in control glands of the same cow. Yield from all quarters returned to preoperative levels within 48 h.

Capsular contracture and silicone gel: experimental study

Wistar rats were used to study the effects, if any, of membrane thickness and implant volume of a silicone gel prosthesis on the development of fibrous capsule contraction. A total of 30 miniprosthesis with three different membrane thicknesses and two different volumes were implanted in the subcutaneous space of five animals. One hundred eighty days later the fibrous capsule was resected and histologically analyzed. Different grades of thickness were observed. The statistical analysis of the data indicates that the thickness of the prosthesis' membrane and the implant's volume did not impact significantly on the grade of fibrosis.

Effect of tissue adhesives and suture patterns on experimentally induced teat lacerations in lactating dairy cattle

Tissue adhesives and suture materials were evaluated for repair of experimentally induced teat lacerations in 6 lactating dairy cows. Group-1 teat lacerations were not closed and served as nonsutured controls. Group-2 lacerations were closed in three layers (mucosa, submucosa, and skin) by use of 3-0 polydioxanone. Group-3 lacerations were closed by use of N-butyl cyanoacrylate monomer tissue adhesive. Group-4 lacerations were closed by use of a combination of sutures and tissue adhesive. All cows were milked by machine. Healing was observed for 28 days, then cows were slaughtered, and teats were recovered for further study. Evaluation revealed failure of healing of all layers with formation of large fistulas in 3 of 4 nonsutured control teats in group 1. All 6 teat lacerations in groups 2 and 3 healed satisfactorily with no fistulas. Five of 6 teats in group 4 had partial healing of skin and mucosa with no fistulas, and 1 teat failed to heal and developed a small fistula. Data indicated that closure of experimentally induced teat lacerations with three layers of fine absorbable suture or closure with tissue adhesive alone gave good results and satisfactory healing of all layers. However, when sutures and tissue adhesive were used together, foreign body reaction was marked, and the skin and submucosa healed only partially. Sutures appeared to entrap the tissue adhesive, resulting in a foreign body reaction.

Surgical treatment of a mural teat abscess in a cow

A 6-year-old multiparous Holstein cow was admitted for evaluation of progressive milk flow obstruction of one quarter of the udder. Physical examination findings suggested the presence of a mural teat abscess. Ultrasonography substantiated the physical examination findings and delineated the extent of the lesion. Surgical excision of the abscess en bloc yielded satisfactory functional and cosmetic results.

Effects of teat cistern mural biopsy and teatoscopy stab versus longitudinal incision with or without tube implant on incisional healing in lactating dairy cattle

Effects of teat cistern mural biopsy and full-thickness stab and longitudinal incisional healing were evaluated experimentally on clinically normal teats in 12 lactating dairy cattle. Each teat on each cow was assigned by Latin-square design to 1 of 4 surgical interventions: (I) teatoscopy only; (II) teatoscopy, stab incision, and mural biopsy; (III) longitudinal incision and mural biopsy; and (IV) longitudinal incision, mural biopsy, and tube implantation. Teatoscopy was done with a 4-mm OD arthroscope introduced through the teat canal and attached to a television camera. Teatoscopy was quicker to perform and provided a more detailed videotaped examination of the teat and gland cistern, compared with gross inspection through a longitudinal incision. In intervention-II cows, the Ferris-Smith biopsy instrument jaws introduced through a longitudinal 1-cm midteat stab incision were easy to visualize and manipulate accurately. Stab incisions closed with only 1 or 2 skin sutures healed without complications in all 12 teats. On palpation, stab incisions were significantly (P less than 0.01) less thick than longitudinal incisions at 8 weeks and were microscopically indistinguishable from the normal tissue. However, in 24 teatoscopically examined teats, 9 (38%) had microscopic evidence of teat canal injury and 12 (50%) of the quarters developed mastitis. This was attributed to trauma resulting from introduction of the arthroscope through the teat canal. Intervention III yielded satisfactory results with the least complications. All 12 longitudinal incisions healed by primary intention, and all teats remained patent. Mastitis developed in 4 (33%) quarters. Intervention IV caused considerable complications associated with the tube implant and no improvement in biopsy site healing, compared with interventions II and III. Eleven longitudinal incisions healed by primary intention. One incision dehisced, 2 (17%) tube implants dislodged, 2 (17%) became obstructed proximally, and irritations of the mucous membrane developed in 2 teats proximally and in 6 teats distally. Mastitis developed in 6 (50%) quarters. Longitudinal incisions healed with moderate submucosal fibrosis. All sutured incisions had multifocal microgranulomata in which suture material was in various stages of degradation. At 8 weeks, localized teat wall thickening could be detected at incisional and biopsy sites, but did not obstruct milk flow. Excessive granulation tissue was at the biopsy sites (72 total) at 2 weeks, and at this time, the sites were partially covered by metaplastic squamous epithelium. However, by 8 weeks, 71 (98%) of the areas were replaced by fibrous tissue with minimal protrusion into the teat cistern.

Use of mucosal grafts and temporary tube implants for treatment of teat sinus mucosal injuries

A mucosal lesion was created in the center of each test sinus of 6 mature, healthy, nonlactating Holstein cows by resecting a circumferential band of mucosa. Each lesion was then treated by implantation of strip grafts of autogenous oral mucosa, temporary silastic tube implant, or a combination of strip grafts and temporary silastic tube implant. All teats were evaluated for patency 6 weeks after treatment, and tube implants were removed through a second thelotomy incision. All teats were reevaluated for gross and radiographic patency 12 weeks after treatment, and teats were collected for histologic evaluation of lesions. All 4 teats treated with grafts only were obstructed at 6 and 12 weeks after treatment. Incomplete coverage of the lesion with mucosa was observed in all 4 teats. The major source of obstruction was proliferation of epithelium and keratin into the lumen. All 8 teats treated with temporary silastic tube implants alone were patent at 6 weeks after treatment, but were obstructed at 12 weeks after treatment. Foci of mucosa at the lesion site were detected in only 2 of the 8 teats. Obstruction resulted from proliferation of granulation tissue into the lumen. All 12 teats treated with grafts and a temporary tube implant were patent at 6 weeks after treatment and 11 of 12 were patent at 12 weeks after treatment, although marked luminal narrowing was evident in 9 of 11 teats. Partial to complete coverage of the lesion with mucosa was seen in all teats. Proliferative granulation tissue, epithelium, and keratin contributed to luminal narrowing in 10 of 11 patent teats. Bacteriologic culture of quarters from 6 of the 11 teats patent at the final evaluation yielded pathogens.

Surgical treatment of accessory teat and gland cistern complexes in three cows

The diagnosis of accessory teat and gland cistern complexes, a technique used for surgical removal of the fistulae, a method for connecting 2 complexes at the level of the teat cisterns, and complications observed after the procedures are described for 3 cows. All cows produced greater than 8,000 kg of milk during the lactation in which surgery was performed. The surgical procedure may be economically justified in cows that are high milk producers or have the genetic potential for high milk production.

Sampling of the bovine teat for studies of defence mechanisms and inflammatory reactions based on a surgical procedure separating the teat and udder cisterns

A surgical procedure to separate the teat and udder cisterns in the udder quarter was described. The sampling method used and its influence on the somatic cell count and bacteriological status of the teat samples were determined. The surgical procedure resulted in complete separation of the teat cistern from the udder cistern in nine out of fourteen teats in six cows. An increase in SCC was seen in one of nine teats during the sampling period of 4 to 8 days. Coagulase-negative staphylococci were isolated in samples from three of six teats at the end of the sampling period. The described methods could be of considerable importance in future studies of inflammatory reactions and defence mechanisms in the bovine teat.

Treatment of teat obstruction in a cow by transfer of oral mucosa and temporary implantation of an intraluminal tube

A dairy cow was examined because of extensive obstruction of a teat cistern. The teat was treated by surgical resection of scar tissue, transplantation of an oral-mucosal autograft, and temporary implantation of a silastic tube. The silastic tube became dislodged from the teat, and was surgically removed 30 days after the initial surgery. The cow subsequently had 2 normal lactations. Prior to the third postoperative lactation, the cow developed severe udder edema. During lactation, the surgically treated teat became hard and was difficult to milk. The cow was then culled.

Primary teat neoplasia in two yearling heifers

Two yearling heifers developed rapidly growing soft tissue masses attached to the base of the right hind teat. In each heifer, the solitary mass was raised, firm, and attached to the overlying skin. En bloc removal was accomplished in each by positioning the heifer in dorsal recumbency and by using local infiltration analgesia. Histologic examination revealed one of the masses to be fibroma and the other, fibrosarcoma. Neither tumor has recurred, and normal function of the teat was retained.

Effectiveness of prophylactic mastectomy in the prevention of breast tumors in C3H mice

The effectiveness of prophylactic mastectomy in the prevention of breast tumors was studied in spontaneous breast-tumor-forming C3H mice. Prolactin levels were assayed to determine if this hormone was related to the incidence of mammary tumors. Two-hundred and fifty-six 1-month-old C3H mice were divided into four groups (control, 1; sham surgery, 2; mammectomy 50 percent, 3; and mammectomy 100 percent, 4). At the time of sacrifice (0 to 1 year postoperatively) estrus cycles were determined, ventral skin (breast) and ovaries were removed for histology, and serum was collected for prolactin assays. Prolactin levels 24 hours postoperatively were significantly elevated (p less than 0.01) in groups 2 to 4 when compared with group 1. Six months postoperatively, prolactin levels were significantly higher (p less than 0.05) in mice with tumors compared with those without tumors in groups 3 and 4. There were no differences in tumor incidence between the four groups. At 12 months postoperatively, no differences in prolactin levels were noted, but group 2 animals had the highest incidence of mammary tumors (89 percent; p less than 0.01) when compared to groups 3 and 4. Mammary tumor incidence was not decreased by 50 percent or 100 percent mammectomy in C3H mice. Prolactin levels rose in response to surgery and/or anesthesia and remained elevated only in tumor-bearing mice who underwent mammectomy, an occurrence similar to that reported in humans.

The influence of silicone bleed on capsule contracture

The phenomenon of silicone bleed from breast implants has been recognized for several years, but its importance continues to be a source of controversy. Experiments were done in rabbits in which standard implants were compared with implants that had been modified to reduce silicone bleed. Contracture was seen with both types of implants, but both the incidence and severity were significantly reduced with the low bleed implants.