| 10.
The two toggle suture ends are then tied together, using
a number of square knots to suit the surgeon's preference.
It is suggested that a vertical distance of 3-4 inches (8-10cm)
be left between the abdominal wall and the knots.
*If using the Toggle Button*
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.
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..
It
is our clinical impression that cows respond better when
the procedure is carried out this way, reducing the likelihood
of fistula formation and pressure necrosis at the perforation
site. Post operative medications are often easiest to administer
at this point in the procedure.
11.
The cow is then rolled clockwise, as viewed from the rear,
and then to normal sternal recumbency.
Remove
the restraint ropes. If tranquilization/sedation has been
used during the procedure, it may be reversed at this time.
Allow
the cow to rise if circumstances warrant.
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