Figure legends:
Figure 1: Anatomy of the perineal area of the mare
Figure 2: Hernia presentation: during the first evaluation, the
swelling was detectable mainly on the right side. The cutaneous abrasion
supports the chronicity of the herniation. The left side appeared
normal.
Figure 3: Poor vulvar conformation of the mare (according to Caslick
Index) which could have led to the perineal muscle weakness and could
have predisposed to herniation.
Figure 4: Standing appositional herniorrhaphy procedure on the right
side a) Preparation of the operative field, b) Blunt dissection of the
skin and underlying fascia, c) Dorso-ventral 12 cm linear skin incision,
d) Hemostasis performed using Enseal® - Ethicon forceps (arrowed), e)
Thin and hypotrophic remnants of the levator ani, f) Hernia breach, g,
h, i) which involved the coccygeus, remnants of the levator ani, and the
external anal sphincter muscles which were then anchored to the
sacrotuberosus ligament and the periosteum of the ischium, j) Final
result with skin suture on both sides of the perineal area
Figure 5: Re-herniation of the hernia content ventrally to the
herniorraphy on the left side
Figure 6: Transposition of the semimembranosus muscle a) Preparation of
the operation site, b) Dorso-ventral 20 cm linear skin incision, c)
Identification of the semimembranosus muscle, d, e) Muscle transection
using an emasculator and ligation with a transecting suture of the
remnant muscle, f) Open superficial muscular fascia, g, h) 45° degree
proximo-medial transposition of the semimembranosus muscle and defect
closure, i) Muscular fascia closing using a simple interrupted suture j)
Skin suture with horizontal mattress sutures.