CAL 2: Practical choices for suturing, surgical staples and tissue glue Flashcards
What would you use to close the linea alba after a laparotomy in a 25kg labrador? MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: Slowly absorbed, synthetic monofilament EXAMPLE: Polydioxanone, polyglyconate, glycomer 631 SIZE: 3.5 metric NEEDLE: taper-cut PATTERN: simple continuous
What is a good general rule of suture material size?
3 metric for an average dog 2 metric for average cat/small dog Add 0.5-1 metric sizes where extra strength is needed Subtract 0.5-1.5 metric sizes wherer high tensile strength isn’t needed or tissue is delicate
How would you close the SC fate of a 15kg cocker spaniel? MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: rapidly absorbable, synthetic monofilament EXAMPLE: polyglecaprone, polyglytone SIZE: 2 or 3 metric NEEDLE: taper-cut PATTERN: subcuticular (continuous)
When is a cutting needle not needed?
if tissue has little collagen
How would you place a subcuticular suture in a 4kg cat? MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: rapidly absorbable, synthetic monofilament EXAMPLE: polyamide (nylon), polypropylene SIZE: 2 or 3 metric NEEDLE: taper-cut PATTERN: subcuticular (continuous)
How should the skin be closed following a ventral midline laparotomy in a 20kg Golden Retriever. You have placed a subcuticular pattern, but it hasn’t resulted in good apposition. MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: synthetic monofilament, non-absorbable EXAMPLE: nylon or polypropylene SIZE: 2 or 3 metric NEEDLE: cutting or reverse cutting PATTERN: simple interrupted
When is a cutting or reverse needle needed?
high collagen content
What pattern gives the most accurate approximation of skin edges?
simple interrupted
Closure of the skin following a ventral midline laparotomy in a 2.5 kg cat. The cat is hypotensive and you would like a rapid closure so that the cat can be recovered from anaesthesia as quickly as possible. MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAl: Synthetic monofilament non-absorbable EXAMPLE: Polyamide (nylon), polypropylene SIZE: 1.5 or 2 metric NEEDLE: Cutting or reverse cutting PATTERN: Ford interlocking
Which gives a better apposition of skin edges? ford interlocking, simple continuous, running suture
Ford interlocking
True/False: If a subcuticular suture has been placed and resulted in accurate apposition, then suture closure of the skin may be omitted
True
T/F: skin staples produce a more rapid closure (vs. sutures)
True
Closure of the stomach wall following gastrotomy to remove a foreign body in a 15kg border Collie MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: Rapidly-absorbed synthetic monofilament absorbable EXAMPLE: Polyglecaprone SIZE: 2 metric NEEDLE: Taper-cut PATTERN: Simple continuous, either a 1-layer closure or a 2-layer closure
When is it best to use a taper-cut needle?
it is the best compromise between avoiding suture cut-through with a cutting needle and avoiding the trauma to the tissue that may occur if a more blunt needle, e.g. taperpoint, is used.
How would you close the jejunum following an enterotomy to remove a FB in a 1.5kg kitten? MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: Rapidly-absorbed synthetic monofilament absorbable EXAMPLE: Polyglecaprone SIZE: 2 metric NEEDLE: Taper-cut PATTERN: Simple interrupted, single layer (or simple continuous)
Why is an inverting pattern not used to close jejunum following enterotomy?
to avoid luminal compromise
How would you perform an anastomosis of the remaining proximal and distal colon following subtotal colectomy for acquired megacolon in a 4kg cat. MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: Slowly-absorbed synthetic monofilament absorbable EXAMPLE: Polydioxanone, Polyglyconate, Glycomer 631 SIZE: 1.5 or 2 metric NEEDLE: Taper-cut PATTERN: Simple interrupted, single layer (or simple continuous)
How would you anchor a gastrostomy feeding tube to the stomach in a 15kg WHWT following removal of an oesophageal FB? MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: Slowly- or rapidly-absorbed synthetic monofilament material EXAMPLE: Polyglecaprone or Polydioxanone/Polyglyconate/Glycomer 631 SIZE: 2 metric NEEDLE: Taper-cut PATTERN: Purse-string (main use for this suture)
What happens if a purse string suture is tied too tightly?
tendency to evert (particularly if bites are placed far from edge and if care isn’t taken to invert wound edges)
Is polyamide/nylon or polyproylene easier to handle and cheaper?
polyamide (nylon)
How would you place stay sutures in the bladder wall following a cystotomy in a 4kg cat? MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: Synthetic monofilament, non-absorbable suture (actually any since sutures are being placed for atraumatic manipulation of tissue and will be removed at end of procedure) EXAMPLE Polypropylene, Polyamide SIZE: 1.5 or 2 metric NEEDLE: Taper-cut PATTERN: Simple interrupted loop (usually, left untied with ends clamped in jaws of haemostat) or cruciate mattress (when more traction is needed, e.g. stomach)
How would you close the bladder following cystotomy to remove several cystic calculi in a 30kg dalmation? MATERIAL EXAMPLE SIZE NEEDLE PATTERN
MATERIAL: Rapidly-absorbed synthetic monofilament EXAMPLE: Polyglecaprone SIZE: 2 metric NEEDLE: Taper-cut PATTERN: Simple continuous, either 1-layer or 2-layerHo
Why might you use a Czerny pattern when closing bladder?
to avoid exposure of suture material to urine
When might you use a 1 and a 2-layer suture pattern for bladder wall?
1 layer: if bladder wall is a normal thickness 2 layers: if bladder wall is thickened (one layer = mucosa +submucosa; other layer = muscularis and serosa)
