The purpose of the toggle button in LDA toggle repair and terine/vaginal prolapse repair is to reduce suture tension by distributing the pressure of the sutures over a wide surface area. When used for umbilical hernia repair, the button serves as a flat surface to contain the reduced hernia, held in place by glue and wrapped tape.

A. Use of Button in LDA Toggle Suture Repair

Step 1. After the two toggle sutures have been placed and clamped, according to the instructions enclosed with the Grymer/Sterner® toggle suture repair kit, the 2 suture ends are threaded through the holes in the button that most closely match the distance between the 2 toggle sutures.

(LDA Repair - Step 1)

Step 2. A vertical distance of 3-4 inches (8-10 cm) should be left between the surface of the button and the square knots, which
join the 2 toggle sutures. This distance allows for normal anatomical shifting when the cow returns to sternal recumbency, reducing the likelihood of fistula formation or pressure necrosis at the perforation site.

(LDA Repair - Step 2)

Step 3. It is not necessary to cut the sutures or remove the button once the cow recovers. However, it is important that the toggle suture button remains in place for a minimum of 12 days.

B. Use of Button in Uterine/Vaginal Prolapse Repair

Step 1. After the uterus/vagina has been replaced (returned to its proper position), horizontal mattress sutures are placed through the holes in the button on each side of the lips of the vulva.

Step 2. Tie the suture knots at a tension appropriate to preclude re-prolapse.

Step 3. If the area of the repair warrants, 4 buttons (2 on each side) can be used to distribute the tension of the sutures over a wider area, according to the surgeon’s preference.

Step 4. Remove the sutures and buttons when appropriate and the cow is no longer straining.

C. Use of Button in Umbilical Hernia Repair

Step 1. Small umbilical hernias can be repaired by gluing a button to the hernia sac using heat detector patch glue.

Step 2. The hernia is then reduced and held in place by wrapping the abdomen with several rolls of adhesive backed elastic tape.

Step 3. Remove the tape and button after 2-3 weeks.

NOTE: not recommended for calves over 250 lbs. or for hernia repairs over three inches in length.